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No 

i 

Boston 

Medical   Library 

Association, 

19     BOYLSTON     PLACE. 

2.         ^ 


THE 


Peninsular  and  Independent 


MEDICAL  JOURNAL, 


DETOTED    TO 


Mem,  Sttrprg,  m^  ftarmats. 


EDITORS: 


A.  B.  PALMER,  A.  M.  M.  D. 

Professor  of  Materia  Medica,  Therapeutics,  and  Diseases  of  "Women  and  Children, 
in  the  University  of  Michigan. 

MOSES  GMN,  A.  M.  M.  D. 

Professor  of  Surgeiy  in  the  UniYersity  of  Michigan. 

^  FREDERIC  STEARNS. 

Pharmaceutist. 


VOLUME  II. 


DETROIT   MICH.: 

HIGBY    &    STEARNS,    PUBLISHERS. 

BAENS,    FRENCH    <fc   WAY,   PEENTERS. 


LIST  OF  CONTRIBUTORS. 


'A/'  HORTON",  L.  S.,  H.  P.  to  U".  S.  Ma- 

ALDEN,  JOHN  M.,  M.  D.  rine  Hospital,  Detroit. 

BEECH,    J.  H.,    M.   D.,    Coldwater'  INGLIS,  RICHARD,  M.  D.,  BeiroH. 

Mich.  JOHNSON,   W.    H.,    M.  D,    Ahion. 

BLISS,  Z.  E.,  M.  D.,  Ionia,  Mich.  Mich. 

BROWN,    J.  A.,    M.   D.,    Kankakee  PALMER,    O.  D.,    M.  D.,   Zeleinople, 

City,  III.  Pa. 

CARUTHERS,  H.,  M.  D.,  Tarrytown  PATTERSON,  M.  A.,  M.  D.,  Tecum- 

CHRISTIAN,  E.   P.,   M.  D.,    Wyan-  seh,  Mich. 

dotte,  Mich.  POTTER,  A.  0,,  M.  D.,  Mantorville, 

CORBIN,  G.  E.,  M.  D.,    Stockbridge,  Minn. 

Mich.  RYND,  CHAS.,  M.  D.,  Adrian,  Mich. 

ERNI,    HENRY,    M.   D.,    Nashville,  SAGER,   ABRAM,  M.  T>.  and  Prof., 

Tenn.  Ann  Arbor,  Mich. 

GIBBS,  Ow.  C,  M.  D.,  Frewshury,  N.  TYLER,  D.  M.,  M.  D.,   Ann  Arbor, 

York.  Mich. 

HITCHCOCK,  H.   0.,  M.  D.,   Kala-  WAGGONER,  F.  R.,   M.  D.,  Oconee, 

mazoo,  Mich.  Illinois. 


Digitized  by  tine  Internet  Arcinive 

in  2012  with  funding  from 

Open  Knowledge  Commons  and  the  National  Endowment  for  the  Humanities 


http://archive.org/details/peninsularindepe02detr 


INDEX   TO  VOL.  II. 


•  ♦  • 


Original  Communications. 

Address  to  the  G-raduating  Glass  of  the 

University  of  Michigan 65 

Air  passages,  foreign  body  in  the 81 

Alkaloids,  Detection  of 10 

Anaesthesia  during  sleep 648 

Brain  disease,  A  case  of 14 

Cannabis  Indica 12 

Carbonic  Acid  Gas  as  a  Local  Anassthe- 

tic  Agent 390 

Cathartics  in  Peritonitis 513,    586 

Chronic  Conjunctivitis,  Treatnaent  of. .     269 
Chronic  Inflammation  of  the  Uterus, 

Studies  for  the  Elucidation  of  the . . .    524 
Criminal  Abortions,  Report  to  the  State 

Medical  Society  on 129 

Criticism,  A 143 

Criticism,  A,  criticised 262 

Detection  of  Alkaloids 10 

Dysentery,  What  is  the  proper  dose  in    534 

Erysipelas,  Puerperal  Fever  and 641 

■  Ether  and  Chloroform 321 

Femoral  Hernia,  Strangulated,  A  novel 

case  of 257 

Foetus  in  Utero,  Peculiar  Death  of 207 

Foreign  Body  in  the  Air  passages 81 

Halminth,  Observations  on  the  Deve- 
lopment of  a  New  Species  of 449 

Hernia.  A  Remarkable  Case  of 259 

Hernia,  Reducible,  Operations  for  Cure 

of 577 

Hernia,  Strangulated,  Two  Cases  of. . .     266 
Hernia,  Strangulated  Femoral,  A  novel 

case  of 257 

Hip  and  Shoulder  Joints,  Luxations  of    193 
Human  Skin,  The  Vegetable  Parasites 

of  the 385 

Hypertrophy  of  the  Heart  during  C-es- 

tation,  The  normal 327 

Hypnotism 723 

Luxations  of  Hip  and  Shoulder  Joints.     193 

Malpractice,  Suits  for,  Influence  of 747 

Meteorological  Register  17,  88, 148,  209,    271 
338,  408,  453,  538,  690,  651,     762 

Milk  Sickness 5 

New  Methods  of  Resuscitation 84 

Notes  on  some  Cases  of  Heart  Diseases    727 
Observations  on  the  Development  of  a 

New  Species  of  Halminth 449 

Observations  on  Specialities  in  Medi- 
cine          1 

On  Turning  the  Foetus  in  Utero .     705 

Peculiar  Death  of  a  Fostus  in  Utero. . .     207 

Peritonitis,  Cathartics  in 513,    586 

Poisonous  Symptoms  of  Tartar  Emelic    717 
Reducible  Hernia,  Operations  for  the 

Cure  of 577 

Report  of  an  Austrian  Trial  for  Rape. .     722 
Report  to  the  State  Medical  Society  on 

Criminal  Abortions 129 

.  Resuscitation,  New  Methods  of , . . ,      84 

Selections  from  Surgical  Notes 140 

Setting  Aright,  A 392 

Sleep,  Anaesthesia  during 648 

Specialties  in  Medicine,  Observations 

on 1 

Strangulated  Hernia,  Two  Cases  of 266 

Strangulated  Femoral  Hernia,  A  novel 

case  of 257 

Studies  for  the  Elucidation  of  Chronic 

Inflammation  of  the  Uterus 524 

Surgical  Notes,  Selections  from 140 

Tetanus 760 

■J^eatment  of  Chronic  Conjunctivitis. .    269 


Vegetable  Parasites  of  the  Human 
Skin,  The 385 

Bihliographical   Reccn^d. 

Address  to  the  Ohio  College  of  Dental 

Surgeiy 19 

An  Epitome  of  Baithwaite's  Retro- 
spect of  Practical  Medicine  and  Sur- 
gery-   766 

Bane  and  Antidote.  The 19 

Campbell,  Report  on  the  Nervous  Sys- 
tem in  Febrile  Diseases 149 

Carnochan's    Operative    Surgery    and 

Surgical  Pathology 211 

Churchill's    Pulmonary  Phthisis   and 

Tubercular  Diseases 592 

Cleveland  Medical  G-azette 282 

Dalton's  Human  Physiology 281 

Dental  Reporter,  The 19 

Druggist,  The 90 

Durkee's  Gonorrhosa  and  Syphilis 339 

Enteric  Fever,  A  Practical  Treatise  on  409 
Favorite  Prescriptions  of  Living  Amer- 
ican Practitioners 18 

Five  Essays 149 

Flint's  Diseases  of  the  Heart 652 

Fowrie's  Chemistry 595 

Habershon's  Diseases  of  the  Alimenta- 
ry Canal 591 

Hunter's  Treatise  on  the  Venerial  Di- 
sease   90 

Introductory  Lectures  and  Addresses 

on  Medical  Subjects 764 

King's  Microcopists  Companion     .    ...  150 

Knickerbocker  Magazine,  The 18 

Medical  Heroism 272 

Malformations  of  the  Urinary  Bladder  19 

Malgaigne's  Treatise  on  Fractures 89 

National  Qtiarantine  and  Sanitary  Con- 
vention, Proceedings  of 639 

North  American  Medical  Reporter 282 

Parish's  Practical  Pharmacy 594 

Physicians,  Handbook  of  Practice  for 

I860 541 

Practical  Treatise  on  Fractures    and 

dislocations _  751 

Tanner'sDiseases  of  Infancy  and  Child- 
hood   210 

Taylor's  Poisons  in  Relation  to  Medical 

Jurisprudence 596 

Editorial  Department. 

Alcohol,  its  place  and  powers 679 

American   Pharm.    Association,    Pro- 

ceediDgs  of,  for  1859 670 

Announcement,  An 64 

Annual  Dinner  of  N.  Y.  Society  for  the 
Relief  of  Widows  and  Orphans  of  Me- 
dical men 597 

Appointment,  A  good '.'..'.  683 

Artificial  Limbs,  Palmer's .' ."  20 

Association  of  Judge  Mason  with  Mann 

&Co 615 

Blackwood's  Magazine 614 

Catawba  Brandy  as  a  Mediciral  Agent  215 
Cincinnati  Lancet  and  Observer,  Re- 
traction of 92 

Clinical  School  of  the  Medical  Depart- 
ment of  the  University  of  Michigan . .  98 

Coecum,  Diseases  of  the 26 

Communication,  A 665 

Controvers}',  Medical 411 

Correction,  A '*"_"  684 

Discontinuance  of  the  Journal !  Ill ! ! '.  1 !  768 


¥1 


Index    to    Vol   IT. 


Diseases  of  the  Ccecum ..,,..;...  26 

Editorial  Correspondence,  156,  217, 455,  542 

616,  655 

Errata , 615 

Erratum 164 

Eavor,  A 684 

Erench  Pharmaceutical  Preparations. .  288 

Eurniture  Labels,  The  Leaf  sets  of 684 

Indigenous  Plants,  Our 155 

Journal,  A  l^evr 609 

Langenbeck's  Tracheotomy  Hook 97 

Laryngoscope,  The 98 

Meeting  at  Louisville,  The 153 

Medical  Controversy 411 

Medical  Chronicle,  The 163 

Medical  Convention  for  Revising  the 
Pharmacopoeia  of  the  United  States, 

The 99 

Medical  Education  in  Chicago 213 

Medical  G-azette,  The  Cleveland 659 

Medical  Press,  The  New  York 558 

Medical  Students,  The  Pharmaceutical 

Education  of 283 

Medical  Teachers'  Convention,  The  late  151 
Michigan  State  Medical  Society,  Pro- 
ceedings of  the  8th  Annual  Meeting  of  682 

Michigan,  State  University  of —  454 

Our  Indigenous  Plants 155 

Palmer's  Artificial  Limbs 20 

Peninsular  and  Independent    Medical 

Journal,  To  the  Subscribers  to  the  —  683 
Pharmacopoeia   of  the  United  States, 

Medical  Convention  for  Revising  the  99 

Prepayment  of  this  Journal 164 

Professor  Allen— Rush  Med.  College..  343 

Publisher's  Card,  The 26 

Resignation _  164 

Rush  Medical  College— Prof.  Allen 343 

Serapion  Society  of  the  Medical  Depart- 
ment of  the  University  of  Michigan—  669 

Tobacco,  The  Use  and  Abuse  of 678 

Tracheotomy  Hook,  Langenbeck's 97 

University  of  Michigan 754 

University  of  Michigan,  Catalogue  of 

Ofllcers  and  Students  of  the,  for  1859  677 

Validictory- 763,  764 

Woman's  Hospital  Association  of  New 

York 678 

Selected  Articles,  Abstracts,  ^c. 

[Translations  from  Foreign  Journals  for  the  Peninsu- 
lar and  Independent.] 

Auscultation,  the  Employment  of  Water 

in 419 

Health  Ofllcers  in  City  and  Country, 

The  Relative  Number  of 172 

Nitrogenous  Food,  Digestion  of 348 

Osteoplastic  Prolongation  of  the  Bones 

of  the  leg,  Pirogofl''s 413 

Premature  Birth,  Artificially  produced, 

Dr.  Lampe  on _  101 

Premature  Labor,  produced  by  the  Ute- 
rine Douche 344 

Vesico- Vaginal  Eistula,  The  improve- 
ments to  Operations  for 44,  167 

Abortion,  Attempted,  Death  from  En- 
trance of  Air  into  the  Veins 463 

Achillea  Millefolium  in  Uterine  Con- 
gestion    689 

AconitumNapellus 565 

Acute   Otitis 368 

Adhesive  Plaster  in  Maintaining  Ex- 
tension  238,  304 

Adipocere,  Remarkable  Case  of 476 

Albuminous  Anasarca,  Tannin  in  Large 

Doses  in , 433 


Alkaloids,  Solubility  of,  in  Fat  Oils-—  438 

Alum  and  Lavin  in  Condylomata. 367 

Alum  on  Bougies  in  Strictures. 432 

Anaesthesia  During  Sleep 564 

Anaesthesia  by  Chloroform 571 

Antidote  for  Phosphorus 314 

Application  of  Q-lycerine  in  Variola,  On 

the 176 

Arsenic  in  Menorrhagia,    Leucorhcea' 

&c 698 

Arsenic,  Mode  of  Applying  to  Destroy 

Nerve  of  a  Tooth 562 

Artificial  Tympana,  Otorrhcea  and 111 

Ash  Tea  as  a  Remedy  for  the  Bite  of  a 

Rattlesnake 57 

Atropia  in  Epilepsy 179 

Atropia,  Traumatic  Tetanus    success- 
fully treated  by 175 

Bibron's  Antidote  for  the  Bite  of  Poi- 

nous  Reptiles .-  433 

Bismuth  Snuff"  in  Coryza 241 

Blood,  Red  and  Dark 370 

Breath,  Fetid 438 

Carbonate  of  Ammonia  in  the  Bite  of 

Poisonous  Reptiles 54 

Chalybeate  Waters,  The  Eff"ects  of  .  - .  -  367 
Chloride  of  Zinc,  A  new  method  of  ap- 
plying   699 

Chloroform,  Death  from 566 

Chloroform  in  the  Treatment  of  Itch—  490 
Chloroform  in  Lithotomy  and  Amputa- 
tion    472 

Chloroform,  Modus  Operandi  of 366 

Chloroform,  Tests  for  the  purity  of 698 

Clavicles,  Fracture  of  both 561 

Clerical  Quackery 690 

Cod  Liver  Oil  Cakes 53 

Collodeon,  Spina  Bifida  treated  by 490 

Ccecum  and  its  Appendix,  Diseases  of 

the 27 

Compound  Syrup  of  the  Hypophospha- 

tesin  Typhoid  Fever 563 

Compressed     Sponge,     Antidactiscent 

Properties  of 638 

Compressed  Sponge 312 

Condylomata,  Alum  and  Savin  in 367 

Condy's  Fluid  in  Ulcerated  Surfaces.  _.  374 

Consumption,  Dr.  Churchill  on 50 

Copaiba,  Balsam  of,  in  Psoriasis —  239 

Copaiba,  Balsam  of,  Tests  of  its  Genui- 
neness   370 

Croup 368 

Cutaneous  Diseases,  On  the  Use  of  Pot- 
ash in  491 

Cutaneous  Maladies,  White  Lead  Paint 

in 434 

Diarrhoea  of  Children,  Raw  Meat  in  the  428 

Delirium  Tremens,  Lupulin  in  ... 688 

Diabetes,  Treatment  of 432,  478 

Digitaline,  The  Action  and  Uses  of 373 

Diptheria 107 

Diseased  Membranes,  Preservation  of 

Specimens  of 52 

Disinfecting  Agent,  Anew 484 

Emboli 481 

Enema,  Port  Wine 53 

Enteric  Juice 363 

Epilepsy,  Atropia  in 179 

Epilepsy,  Marsh  Salinumin 693 

Erysipelas  of  the  Limbs,  Treatment  of 

by  Elevation 179 

Extracted  Tooth,  Replacement  of  an .  _.  563 
Female  Catheter,  A  novel  Substitute 

for  a 313 

Fetid  Breath - 438 

Fibrin,  The  Physiological  Position  of—  241 

Firing  up  with  Mummies 496 

Fracture-box,  Anew —  560 

Fracture  of  both  Clavicles _—..,..  561 


Index   to    Vol.    II. 


Vll 


Gastric  Juice,  Action  of  the,  on  the  Sto- 
mach and  Diaphragm 470 

G-elseminum  Sempervirens .* 686 

Glycerine,  Application  of,  in  Variola. -  176 

Glycerine  Ointment  for  the  Itch 697 

Golden  Sulphuret  of  Antimony  in  Pneu- 

mionia — 699 

Gout  and  its  Remedy 687 

Gums,  Scurvy  of,  Treated  by  Nitrate  of 

Silve.r 377 

Hemorrhoids,  Treatment  of 482 

Hsemostatic  Efi'ects  of  Perchloride  of 

Iron 433 

Hooping  Cough 374 

Hooping  Cough,  Diluted  Mtric  Acid 

in - 239 

Hunter,  John,  Reinterment  of  the  Re- 
mains of 182 

Hydrocele,  New  Method  of  Treating  . .  177 

Hydrophobia,  A  New  Remedy  for 365 

Hydrophone  — 376 

Hypophosphite  of  Quinia,  Tonic  pro- 
perties of 439 

Ingrowing  Nail,  Perchloride  of  Iron  in  241 

Ingrowing  Toe-Nail,  Treatment  of 688 

Infant  in  Uterus,    Respiratory  move- 
ments detectible  by  Auscultation 314 

Intoxication,  Chronic,  Oxide  of  Zinc  in  689 
Iodide  of  Potash,  The  Use  and  Abuse 

of 358 

Iodide  of  Sodium- 373 

Iodine,  A  New  Vehicle  for 698 

Iron,  Tinct.  Mur.  of,  A  Nasal  Polypus, 

cured  by 562 

Itch,  Chloroformin 490 

Itch,  Glycerine  Oint.  for  the 697 

Jerking  Respiration 363 

Joints,  On  Two  Cases  of  Opening  into  467 

Labor,  Lingering  Uva  Ursi  in 490 

Mad  Dogs,  Remedy  for  the  Bite  of 664 

Management  of  the  Shoulders  in  Exa- 
minations of  the  Chest 109 

Mastic  in  Nocturnal    Incontinence  of 

Urine 432 

Meat,  Raw,  in  the  Diarrhoea  of  Chil- 
dren    428 

Medical    Administration   of   Ozonized 

Oils   -—  435 

Medical  College  at  Bombay,   Students 

rofthe 638 

Melanotic  Cancer,  The  Diagnosis  of 367 

Microscope  before  the  Anatomic  Socie- 
ty of  Paris,  The 573 

Morphia  and  Carbonate  of  Soda  for  Re- 
tention of  Urine 240 

Mortality  from  "Whooping  Cough 434 

Mummies,  Firing  up  with 496 

Nausea  and  Vomiting  during  Pregnan- 
cy   491 

Nervous  Headache,  Treatment  of,  by 

Hydrochlorate  of  Ammonia 572 

Neuralgia 53 

New  Method  of  Treating  Hydrocele.. .  177 
Nocturnal  Incontinence  of  Urine,  Mas- 
tic in 432 

Nursing  Sore  Mouth,  Uterine  Disease, 

The  cause  of 178 

Obstinate  Vomiting 179 

Openings  into  Joints,  Two  Cases  of 467 

Ophthalmia,  Purulent 112 

Opium  in  France,  Preparation  of 435 

Opium,    Purity  of 375 

Oracle,  The,  Fairly  Committed-  - 240 

Organic  Diseases  of  the  Heart,  Chronic  482 

Origin  of  Plants 496 

Otorrhoea  and  Artificial  Tympana 111 

Otorrhoea  of  Young  Children 237 

Otitis,   Acute —  --  368 


Ovarian  Disease 565 

Ozena  178 

Ozonized  Oils,  Medical  Administration 

of -----    435 

Perchloride  of  Iron,  Use  and  Properties 

of 695 

Perchloride  of  Iron,  Hjemostatic  eflects 

of 433 

Phagedenic  Ulcer  Tartrate  of  Iron  and 

Potash  in 177 

Phosphorics,  Poisoning   by,    Antidote 

for  -.u - 314 

Phosphorus,  Poisoning  by,  Treatment 

of 366 

Plants,  Origin  of 496 

Polypus,  Nasal,  Cured  by  Tinct.  Mur. 

of   Iron 562 

Poisonous  Reptiles,  Carb.  Amnion,  in 

the  Bite  of 54 

Pregnancy,  Nausea  and  Vomiting  dur- 

^ing 491 

Prolapsus  Uteri 181 

Psoriasis,  Balsam  of  Copaiba  in 239 

Puerperal   Convulsions   Treated   with 

Nettle 52 

Pulmonary  Phthisis,  Saturnine  Medica- 
tion   in 484 

Quackery,   Clerical 690 

Quinia,  Hypophosphite  of,  Tonic  Pro- 
perties of 439 

Quinic  Ether 696 

Rapidity  of  Thought,  or  Nervous  Ac- 
tion      365 

Rattlesnake,  Bite  of  a,  Ash  Tea  as  a 

Remedy  for  the „      52 

Rectal  Alimentation  Questioned 569 

Red  and  Dark  Blood 370 

Reptiles,  Poisonous,  Bibron's  Antidote 

for  the  Bite  of - 483 

Reptiles,  Poisonous,  Carb.  Ammon.  in 

the  Bite  of 54 

Respiration,  Experiments  on  the  Phe- 
nomena of _ 437 

Respiration,  Saccadee 363 

Respiratory  Movements   of  Infant   in 

Uterus 314 

Retention  of  Urine,  Method  of  Reliev- 
ing     240,    376 

Russia,  Popular  Remedies  of 368 

Saturnine    Medication    in   Pulmonary 

Phthisis 484 

Sarsaparilla,  Therapeutical  Properties 

of 362 

Scarlatina,  Iron  in 178 

Scurvy  of  the  Gums,  Treated  by  Nit. 

of  Silver 377 

Senna  Leaves _.    372 

Sleep,  Aneesthesia  during 564 

Snuff,  Bismuth,  in  Cory za 241 

Sodium,  Iodide  of _.    373 

Solubility  of  Alkaloids  in  Fat  Oils .    438 

Speculum,  The  Uterine 307 

Spina  Bifida,  Treated  by  Collodion 490 

Spinal  Diseases,  Lecture  on 480 

Spina  Bifida,  Treatment  of,  By  Injec- 
tions of  Iodine 567 

Stomatitis  Materni 374 

Stricture,  Alum  on  Bougi  esin 432 

Stricture,  Organic,  of  Urethra,  Jod.  of 

Potass,  in 179 

Suppression  of  Illegal  Practice  in  Paris    241 

Tannin  in  Albumnous  Anasarca 433 

Tetanus  cured 665 

Thymus  Gland,  The   Physiology  and 

Pathology  of 241 

Traumatic  Tetanus  Successfully  Treat- 
ed by  Atropia 175 

Tubercular  Diseases,  Alcoholic  Liquors 


Vlll 


Index   to    VoL   II. 


in 632 

Typhoid  Fever,   Compound  Syrup  of 

the  Hypophosphates  in 563 

Ulcerated  Surfaces,  Condy's  Fluid  m. .  374 
Ulcerations,  &c.,  of  the  Os  and  Cervix 

Uteri 425 

Uva  Ursi  in  Lingering  Labor 490 

Use  and  Abuse  of  Iodide  of  Potash,  On 

the 358 

Uterine  Congestion,  Achillae  Millefo- 
lium in 689 

Uterine  Disease,    The  main  cause  of 

IsTursing  Sore  Mouth — 178 

Uterine  Speculum,  The 307 

Varicose  Veins,  Treatment  by  Blister- 
ing   373 

Variola,  Application  of  Glycerine  in . . .  176 

Vegetable  Parasites  of  the  Human  Skin  180 

Vomiting  during  Pregnancy 178 

Vomiting,   Obstinate ^ 179 

White  Lead  Paint  in  Cutaneous  Mala- 
dies    434 

Whooping  Cough 374 

Whooping  Cough,  Mortality  from 434 

Whooping  Cough,  Diluted  Nitric  Acid 

in 239 

Womb,  Falling  of  the 181 

Pharmaceutical  Department. 

Acid  Nitrate  of  Silver,  The 253 

Administration  of    Medicine  to  Chil- 
dren, The 317 

Aesculin  in  Intermittent  Fever 318 

Alianthus,  Vermifuge,  Properties  of...  444 
Alkahes  in  the  Extraction  of  the  Ac- 
tive Principle  of  Plants 191 

Althea  Paper,  A  New  Test  for  Acids 

and  Alkalies 248 

Ammonia,  Aromatic  Spirits  of 383 

Ammonia,  Carbonate  of,  in  Measles 384 

Ammonia,  Liniment  of 384 

Ammonia,  Muriate  of --  57 

Arnica  Montana 381 

Arsenious  Acid,  Hydrate  of  Mag.  Anti- 
dote for  Poisoning  by 189 

Blue  Mass,  Powdered —  —  318 

Caffein,  Preparation  of 444 

Catawba  Brandy,  B.  S.  Wayne  on 380 

Chalybeates,  New 379 

Chickweed 316 

Chloric  Ether  Commercise 639 

Ohromate  of  Potash  in  Warts 318 

Chromic  Acid  in  SyphiliticVegetations  190 
Chronic  Affections  of  the  Eye,  Treat- 
ment of ---: 254 

Citrate  of  Iron  and  Strychnia -  .  189 

Cod  Liver  Oil,  A  Substitute  for 252 

Cod  Liver  OilJelly--- 57 

Concentrated  Lime  Water .. ..-_.-..---  57b 
Confection  of  Cubebs  and  Copaiba  with 

Nit.  Bismuth l90 

Cornea,  Chronic  Ulceration...: 

Dentriflce,  Sulphur  as  a  -.-..--- 44a 

Detection  of  Pregnancy  by  Ergot -  190 

■  Dulcamara  and  Lolanine,  Therapeutical 

Action  of ^*2 

Dysentery,  The  Use  of  G-lycerine  in ... .  443 
Extractive     Principle    of    Vegetables, 

Combination  of  Iodine  with 440 

Fail,  Never  say. 699 

Febrifuge,  Nux  Vomica  as  a 443 

Fluid  Extract  of  Yarrow 247 

Fusel  Oil,  Purification  of  Spirit  from. .  253 

Ginseng  Excitement,  The 315 

Glycerine  in  Dysentery,  TheUseof...  443 
Goulard's  Cerate  Substituted  by  a  Gly- 

cerole  of  Lead - 247 

Honey  of  Roses 192 


Hydrate  of  Magnesia  an  Antidote  for 

Poisoning  by  Arsenious  Acid 189 

Hydrochloric  Acid,   On    the  External 

Use  of 60 

Hypophosphate  of  Quinia 191 

Indian  Medicine 574 

Indigenous  Plants,  New  Therapeutical 

Uses  for  our « 187 

Infusions,  The  Preservation  of _.  248 

Intermittent  Fever,  Aesculin  in 318 

Intermittent  Fevers,  Tincture  Mur.  of 

Iron  in 690 

Iodide  of  Sodium,  Preparition  and  Uses 

of 509 

Iodide  of  Sodium,  The  Employment  of  249 
Iodine,  Combination  of  with  the  Ex- 
tractive Principle  of  Vegetable 440 

Iodized  Food 254 

Iron,  Reduced  by  Carbon 59 

Iron,  Urine  of 384 

Itch,  Ointments 192 

Jelly,  Cod  Liver  Oil 57 

Koussine 253 

Liniment  of  Ammonia 384 

Liquor    Cinchonas    Hydriodatus,     and 

Liq.  Cinchon.  Hydriodat,  Cum.  Ferro  56 

Measles,  Carbonate  of  Ammonia  in 384 

Mercurial  Ointment _ 61 

Mezereum,  Alcoholic  Extract  of 383 

Muriate  of  Ammonia 57 

Nux  Vomica  as  a  Febrifuge 443 

Ointment,  Mercurial 61 

Pepsin  Wine _ 190 

Powdered  Blue  Mass 318 

Pregnancy,  Detection  of  by  Ergot 190 

Preservation  of  Infusions,  The 248 

Progress  of  Pharmacy 701 

Propylamin - 55 

Purification  of  Spirit  from  Fusel  Oil. .  -  253 

Quinia,  Hypophosphate  of 191 

Revulsive  Treatment  of  Chronic  Affec- 
tions of  the  Eye 254 

Saccharated  Lime  for  Use  in  Medicine .  576 

Samaderine 248 

Scammony  Resin,  New  Process  of  Ob- 
taining   —  188 

Silvering  Animal,  Vegetable  and  Mine- 
ral Substances,  Process  for 441 

Solanine,  Therapeutical  Action  of  Dul- 
camara   and 442 

Spanish   Apple,    The 254 

Sulphur  as  a  Dentriflce 445 

Syphilitic  Vegetations,  Chromic  Acid 

in - 190 

Syrup  of  Coffee  for  Whooping  Cough—  383 

Syrup  of  Tar 639 

Ulmus  Fulva 61 

Vermifuge  Properties  of  the  Chinese 

Alianthus,  The 444 

Warts,  Ohromate  of  Potash  for 318 

Whooping  Cough,  A  New  Mixture  for 

the 445 

Whooping  Cough,  Syrup  of  Coffee  for 

the 383 

Wine  of  Iron 384 

Yarrow,  Fluid  Extract  of 247 

Society  Meetings. 

American  Medical  Association.  63,  113,  704 

American  Pharmaceutical  Assoc.  .  319,  509 

Medical  Teachers,  Convention 183 

Michigan  State  Medical  Society.  ..  640,  704 

Correspondence. 

Chicago  Correspondence 62 

Correspondence,  The  American  Medi- 
cal Association- 165 

News  Items.—  127,  255,  320,  377,  446,  512 


THE 


PENINSDLAR  and  mDEPENDENT 


MEDICAL  JOUMAL. 


Vol.  II.  DETROIT,  APRIL,  1859.  No.  1. 


riginal  C0mm«;nirEti0ns» 


AST.  I.— ObseryatioHs  on  Specialties  in  Medicine. 


By  a. 


Division  of  labor  in  scientific  inquiries,  enriclies  science 
by  large  discoveries  of  facts,  and  consequently  is  by  no 
means  to  be  disregarded  or  contemned.  Particularly  have 
the  series  of  sciences  collateral  to  medicine  been  profited 
by  this  mechanical  system.  This  acknowledged  truth,  and 
lis  analogous  illustrations  in  the  varied  departments  of 
art  and  production,  have  of  later  years  exceedingly  influ- 
enced the  domain  of  practical  medicine.  In  the  cycle  of 
ages  the  medical  world  has  revolved  to  a  condition  of 
affairs  precisely  similar  to  that  of  a  remote  antiquity. 

Time  was  when  each  organ  of  the  human  body  was 
placed  in  the  care  of  a  distinct  medical  custodian,  and  not 
unfrequently  when  the  unhappy  patient  died,  the  doctor 
still  triumphed  ; 

"Still  proved  his  reasoning  best,  and  his  belief, 
Though  propped  on  fancies  wild  as  madmen's  dreams, 
Most  rational," 

Vol.  it. -a. 


2  The  Peninsular  and  Independent. 

because,  sooth  to  say,  the  organ  over  which  he  was  the 
presiding  genius,  had  escaped  destruction  before  death. 

En  passant,  this  reminds  of  a  recent  case  where  a 
modern  specialist  glorifies  and  is  glorified,  because  his  pro- 
bang  did  not  transfix  the  tracheal  parietes,  as  was  sagely 
believed  by  the  patient  (who  died,  however),  and  two 
savans,  of  the  medical  sort,  who  attended  him  in  extremis. 
On  the  contrary,  to  the  utter  discomfiture  of  anti-probang- 
dom,  not  only  did  the  triumphant  probang  not  cause  death, 
but  the  larynx  and  trachea  were  wholly  free  from  disease ! 
Truly,  this  modern  cock  who  came  so  near  being  sacri- 
ficed to  jJEscuLAPius  by  the  Nestor  of  American  Surgery  and 
his  colleague,  may  vigorously  crow  over  the  post-mortem 
developments.  Human  larynxes  and  tracheas  will  bear  a 
deal  of  swabbing  when  wholly  healthy,  and  why  not  allow 
anxious  patients  the  luxury,  if  they  can  afford  it  ? 

The  post -pharyngeal  abscess  with  a  post-mortem  hole 
in  it,  the  emphysema,  et  alii,  are  not  within  the  trachea- 
swabbing  domain  —  why  call  upon  the  king  of  medical 
specialists  to  invade  the  territory  of  his  neighbors  ? 

Medicine  is  spotted  and  covered,  dwarfed  and  pauper- 
ized, by  specialisms.  Comprehensive,  profound,  exact,  en- 
larged and  true  views  of  general  practice  are  too  much  lost 
sight  of  in  the  petty  technicalities,  the  mountebank  ma- 
nipulations, the  legerdemain  tactics,  the  microscopic  little- 
nesses of  throat  men,  skin  men,  womb  men,  eye  and  ear  men, 
et  id  omne  genus — ad  nauseam.  Every  square  inch  of  the 
human  body,  from  head  to  heels,  is  dotted  over  with  medi- 
cal homunculi,  wedded  in  heart  and  soul  to  their  particular 
square  inch,  and  knowing  nothing,  caring  nothing,  for  the 
man  as  a  whole. 

And  this  is  but  the  direct  result  of  pandering  to  a  gross 
popular  error,  which  judges  of  practical  medicine  as  it  does 
of  practical  pin -making —  much  to  be  facilitated  by  division 
of  the  processes.      And  yet,  if  there  is  any  one  truth  estab- 


Observations  on  Specialties  in  Medicine.  8 

lished  by  all  medical  experience  and  all  medical  philosophy, 
these  truths  are  established  beyond  reasonable  cavil. 

There  is  no  man  who  knows  so  little  of  the  correct 
treatment  of  the  human  eye  as  the  professed  oculist.  There 
is,  in  like  manner,  no  man  so  deplorably  ignorant  of  the 
human  ear,  as  the  "aurist/'  There  is  no  no  man  so 
dangerous  to  the  integrity  of  the  human  windpipe  and  its 
appurtenances  as  the  "  throat  man/'  There  is  no  man  so 
prolific  in  mischief  to  the  fairer  portion  of  the  race  as  he 
who  displays,  as  the  peculiar  badges  of  his  ministry,  the 
speculum,  the  parte  caustique,  the  sound,  and  the  multi- 
form pessary. 

And  the  catalogue  might  be  extended  indefinitely.  A 
large  proportion  of  this  unmistakable  quackery  has  grown 
up  insidiously  within  the  very  sheepfold  of  the  Profession. 
The  magnates  have  eaten  of  it  to  their  own  rejoicing  of 
pocket,  and  the  tender  lambs  of  the  flock  nibble  assiduously 
at  the  promising  grain,  being  fully  persuaded  that  they 
shall  thereby  be  enabled  to  wax  fat  and,  in  their  turn,  kick 
lustily  at  all  '^irregulars"  —  outside  the  pale  delicianum 
vitianum. 

Whatever  excuse  might  have  formerly  been  afforded  for 
an  attempt  at  division  of  labor  in  the  practice  of  medicine, 
however  attractive  seems  the  opportunity,  the  great  light, 
which  has  of  late  years  been  thrown  upon  the  intimate 
relation  existing  between  the  most  remote  parts  of  the 
human  body,  now  utterly  dispels  the  illusion.  No  man 
who  understands  the  full  import  of  (;omparatively  recent 
,  discoveries  can  now  fail  to  see  that  the  attempt  to  separate 
treatment  of  any  single  part  of  the  body  from  a  complete 
knowledge  of  the  method  of  treating  the  whole,  however 
diseased,  is  like  a  man's  attempting  to  light  a  single  burner, 
when  the  whole  supply  pipe  is  shut  off  at  the  meter.  It 
may  burn  a  little,  a  timid  flickering  ray  or  two,  enough  to 


4  The  Peninsular  and  Independent. 

show  how  dark  the  surroundings  are,  but  speedily  it  is 
gone — precisely  as  the  traveling  specialists  do,  burning 
out  the  supply  in  their  little  pipes,  and  then,  the  places 
which  have  once  known  them  know  them  no, more  for  ever. 

It  is  to  be  feared  that  much  of  this  tolerance  of  spe- 
cialism has  grown  out  of  sheer  indolence.  Acquaintance 
with  what  inquirers  in  special  dejDartments  of  medical  sci- 
ence have  brought  to  light  is  imperatively  necessary  to  the 
conscientious  medical  practitioner,  and  it  is  quite  a  relief 
to  have  some  prophesiers  of  smooth  things  say  that  it  is 
better  to  devote  attention  to  what  observers  in  one  depart- 
ment only  bring  forward.  But  he  only  is  a  reliable  prac- 
titioner who  has  drawn  from  every  well  at  whose  bottom 
Truth  is  —  who  has  thoroughly  grounded  himself  in  the 
lore  of  experience,  and  the  wisdom  of  research  in  all 
science. 

This  idea  is  not  novel— it  is  as  old  as  Bacon.  "In 
particular  sciences  we  see,  that  if  men  fall  to  subdivide 
their  labors,  as  to  be  an  oculist  in  physic,  or  to  be  perfect 
in  some  one  title  of  the  law  or  the  like,  they  may  prove 
ready  and  subtile,  but  not  deep  or  sufficient,  no,  not  in 
that  subject  which  they  do  particularly  attend,  because  of 
that  consent  which  it  hath  with  the  rest.''  ..."  I  mean 
not  that  use  which  one  science  hath  of  another  for  orna- 
ment or  help  in  practice,  but,  I  mean  it  directly  of  that 
use  by  way  of  supply  of  light  and  information,  which  the 
particLilars  and  instances  of  one  science  do  yield  and  present 
for  the  framing  or  correcting  of  the  axioms  of  another 
science  in  their  very  truth  and  notion!' 

Kefer  now  to  the  flood  of  light  which  is  being  thrown 
upon  the  connection  of  remote  parts  of  the  human  body, 
by  the  ingenious  application  of  the  newly -discovered  laws 
of  nervous  action,  to  the  elucidation  of  previously  occult 
phenomena.  The  physiology  of  metastasis,  now  as  clearly 
discoverable  as  the  physiology  of  digestion.      The  epilepsy 


Waggoner  on  Milk  Sichiess.  5 

supplanting  the  disease  which  long  baffled  the  "  skin  man." 
The  phthisis^  which  rewarded  the  efforts  of  the  "os  uteri 
man."  The  diabetes,  which  puzzled  the  "liver  man/'  and 
so  forth,  and  so  on,  to  the  end  of  the  categories. 

One  blood  percolates  all  capillaries — one  nervous  system 
is  webbed  in  and  over  every  organ,  every  tissue.  Take 
away  every  thing  else,  and  nervous  fibre  and  vesicle  map 
out  the  entire  man.  And  yet,  with  these  all -pervading 
elements,  comes  the  Specialist,  and  rejoices,  like  Marius 
at  Carthage,  "alone  amid  ruins,"  that  he  can  yet  play 
manifold  tunes  upon  his  keyless,  valveless  trumpet.  What 
matter  is  it  if  the  hapless  patient,  like  John  Eandolph, 
dies  so  soon  as  he  is  cured?      Egypt  "still  lives." 


ART,  II.— Milk  Sickness. 


By  F.  R.  Waggoner,  M.  D. 

In  reviewing  the  notices  given  in  the  journals,  of  the 
Transactions  of  the  American  Medical  Association,  I  make 
a  special  note  of  Dr.  Sutton's  Eeport  on  the  Diseases  and 
Topography  of  Kentucky,  and  especially  of  his  malarious 
hypothesis  ol  the  etiology  of  Milk  Sickness. 

I  feel,  in  no  small  degree,  timid,  in  making  an  assault 
on  the  doctrines  promulgated  by  a  grave  member  of  the 
learned  American  Medical  Association.  Notwithstanding, 
however,  his  position  and  senile  dignity,  I  claim  a  voice,  if 
I  am  a  junior  brother— I  claim  it  because  my  knowledge 
has  been  derived  from  personal  observation  and  contact  with 
the  fearful  malady,  though  I  know  not  what  the  learned 
M.  D.'s  advantages  have  been  in  securing  data  to  found  his 
hypothesis  on. 

That  its  etiology  is  not  of  a  miasmatic  origin  is  obvious 
from    many  facts  :    1st,  It  is  strictly   an   endemic  disease  ; 


6  The  Peninsular  and  Independent. 

2d,  It*  is  not  known  in  many  malarious  districts  ;  3d,  The 
victim  of  its  toxical  influence  is  aflected  entirely  different — 
that  is,  the  symptoms  of  malarial  diseases  and  Milk  Sick- 
ness are  in  no  case  the  same.  (I  mean  well  defined  malarial 
fevers. ) 

Who  ever  heard  of  the  entire  Mississippi  Valley  being 
affected  by  ^^  Trembles" — yes,  a  State,  or  even  a  county  or 
community — as  has  been  the  case  so  frequently  with  the 
miasmatic  diseases  ?  I  have  witnessed  seasons  when  scarce 
a  family,  of  however  well  regulated  hygienic  habits,  escaped 
the  malady  in  some  of  its  forms — intermittent,  remittent, 
pernicious,  &c. 

But  on  the  other  hand,  the  disease  in  question  is  sub-^ 
j  acted  to  general  and  fixed  rules,  unalterable  as  the  laws 
of  the  Medes  and  Persians,  that  are  obvious  to  the  most 
casual  observer.  1st.  Persons  are  only  liable  to  the  disease 
who  feed  upon  the  flesh,  milk,  &c.,  of  animals  that  pasture 
in  timbered  land,  as  I  have  stated  in  another  article,  in  the 
January  No.  of  this  journal ;  therefore  we  scarce  ever  see  a 
patient  except  along  water -courses  which  are  bounded  by 
woodland  on  either  side.  So,  we  Suckers  know  too  well 
where  to  look  for  "  Milk  Sickness." 

The  topography  of  this  county  (Shelby),  in  which  I 
reside,  is  such  as  to  demonstrate,  as  clearly  as  any  propo- 
sition in  geometry,  that  it  is  not  of  a  malarial  origin.  The 
county  is  a  large  one,  and  is  traversed  from  northeast  to 
southwest  by  the  Kaskaskia  River,  which  has  a  number  of 
tributaries,  under  the  denomination  of  creeks,  draining  the 
country  for  many  miles  east  and  west  of  the  river.  As  is 
common  in  this  Prairie  State,  the  streams  are  skirted  by 
timber,  extending,  in  some  cases,  back  from  the  stream  two, 
three,  and  even  four  miles  in  places.  The  parent  stream, 
the  Kaskaskia,  makes  it  way  through  a  very  broken  coun- 
try, with  but  little  bottom-land;  the  ridges  and  knolls 
reaching  back  for   some  distance,    from  one   to  two  miles^ 


Waggoner  on  Milk  Sickness.  7 

when  a  tableland  sets  in  that  continues  to  the  prairie.  The 
"river  timber"  is  generally  from  five  to  six  miles  across. 
I  would  add  that  this  broken  region  is  covered  by  a  profuse 
white  oak  growth — now  and  then  a  specimen  of  some  other 
variety  of  the  Quercus,  together  with  an  occasional  hickory 
and  walnut,  the  latter  nearing  the  stream. 

The  tableland  is  studded  by  a  va  iety  of  various  species 
of  the  oak,  hickory,  etc.,  while  nearing  the  prairie  the 
timber  becomes  shrubby,  stinted,  and  inferior.  The  soil, 
generally  speaking,  is  of  a  wet,  heavy  clay  character,  which 
is  noted  for  its  productive  qualities  by  the  farmers.  But 
on  the  other  hand,  the  smaller  streams  are  traced  by  a 
growth  of  a  different  character,  as  the  Gleditschia  triacan- 
thus  in  abundance,  TJlnus,  U.  Americana,  U.  fulva,  Cera- 
sus  Serotina,  Celtis,  Crassifob'a,  etc.,  and  an  undergrowth 
of  hazel,  spicewood,  and  of  such  growths  as  are  generally 
found  in  the  black,  sandy  loam  soil.  I  would  say  here, 
that  the  soil  along  these  minor  water  courses  is  not  to  be 
surpassed  in  fertility  in  the  great  Mississippi  Valley,  while 
the  prairies  adjoining  have  soil   in   no   way   inferior. 

It  is  on  the  course  of  those  creeks  that  Milk  Sick- 
ness makes  its  appearance,  and,  as  it  were,  strikes  its 
victim  down  at  noonday,  and  is  emphatically  the  terror 
of  the  forest,  while  the  inhabitants  of  the  Kaskaskia  re- 
gions, together  with  their  horses,  cattle,  hogs,  &c.,  enjoy 
perfect  freedom  from  the  monster.  This  is  a  fact  well 
known  to  every  citizen  of  a  few  years'  observation  with  us. 

To  remark  more  minutely  upon  our  county  topography. 
The  northwest  corner  of  it  is  drained  by  the  terminus  of 
the  south  fork  of  the  Sangamon  Eiver,  whose  immediate 
source  is  in  the  prairie,  and  winds  its  way  for  some  ten 
or  twelve  miles  through  the  same,  without  scarce  a  bush 
or  shrub  to  mark  its  course,  when  it  enters  a  heavy  and 
thick  forest -growth,  the  same  as  described  as  growing  on 
the  tributaries  of  the  Kaskaskia.      It  is  worthy  of  remark 


8  The  Peninsidar  and  Independent. 

that  on  either  side  of  this  prairie -stream,  the  face  of  the 
country  is  very  flat,  and  boggy  in  places.  In  the  wet  season 
of  the  year  the  entire  face  of  the  country  is  almost  covered 
\>j  the  aqueous  fluid.  The  soil  is  of  the  sandy  loam  also  ; 
very  fertile  and  productive,  if  properly  drained  and  culti- 
vated. This  meadow -land  is  a  favorite  resort  for  cattle, 
from  early  spring  to  late  autumn  ;  and,  strange  to  relate, 
never  a  case  of  Milk  Sickness  occurs  among  them,  though  it 
may  he  readily  inferred,  it  is  the  very  hot -bed  of  malaria. 
But  no  sooner  than  our  stream  reaches  its  sylvan  destina- 
tion than  the  malady  of  which  we  treat  clandestinely  exhi- 
bits its  furor. 

But  to  return  to  our  former  topographical  sketch.  The 
Kaskaskia  and  its  adjacent  country  are,  and  ever  have  been, 
as  prolific  in  miasmatic  diseases  as  any  part  of  the  Great 
West,  and,  too,  in  their  most  hideous  and  malignant  form, 
together  with  the  milder  grades,  as  chills  and  ague,  early 
and  late.  The  Doctor's  fee  is  the  only  dread  for  six  months 
of  the  year  ;  but,  I  repeat,  not  a  case  of  Milk  Sickness  has 
ever  been  known  in  all  this  vast  scope  of  malarious  coun- 
try for  the  M.  D.s  to  try  their  skill  upon,  or  to  alarm  the 
credulous.  It  is  nevertheless  those  smaller  streams  which 
are  subjected  to  malaria,  but  not  to  the  extent  that  the 
Kaskaskia  is.  But  on  these  minor  streams  I  repeat  the 
^^ slows''  reign  supreme.  Can  the  learned  Dr.  Sutton  ex- 
plain this  anomaly  ? 

The  country  intervening  those  creeks  is  prairie,  in  some 
cases  to  the  extent  of  ten  or  fifteen  miles,  very  high  and 
draining.  Though  malaria  frequently  visits  its  tenants. 
Milk  Sickness  is  unknoivn  to  their  prairie  abode. 

As  I  am  very  deficient  in  descriptive  faculties  I  will  dilate 
no  farther  on  the  geography  of  Shelby.  I  shall  not  occupy 
much  of  your  precious   space  with  my  ultima  ratio. 

The  symptoms  of  malarial  diseases  *are  so  varied,  nu- 
merous, and  dissimilar,  that  nearly  every  patient  has  symp- 


Waggoner  07i  3filk  Sickness.  9 

toms  peculiar  to  himself,  thougli  every  case  loudly  proclaims 
to  the  experienced  observer  its  etiology.  The  premonitory 
symptoms  of  Milk  Sickness  differ  most  from  malarial.  The 
symptoms  are  langor^  lassitude,  and  a  peculiar  dullness 
and  stupor,  for  several  days  before  the  onset  of  the  attack 
proper  begins  ;  chilliness,  &c.  are  unknown.  The  "  foetor " 
of  the  exhalations  is  a  striking  diagnostic,  and  is  never 
known  in  any  form  of  the  malarial — in  fact,  every  clinical 
manifestation  points   out  a   malady  of  a  peculiar  etiology. 

I  have  heretofore  ventured  an  opinion  on  its  origin,  and 
I  am  now  no  way  inclined  to  retract,  and  only  ask  the  Pro- 
fession to  indulge  me  in  my  way,  and  look  with  me  for  its 
telluric  source. 

It  has  been  iterated  and  re -iterated  that  the  poison  is 
most  virulent  and  plenty  in  the  fall  season,  after  a  hot, 
dry  summer.  That  this  is  true  I  can  not  add  my  testimony, 
but  am  rather  inclined  to  skepticism.     A  few  facts  in  point. 

The  summer  of  1851  was  extraordinarily  wet,  from  the 
latter  part  of  May  until  late  in  August ;  Milk  Sickness  in 
abundance,  at  least  among  stock.  In  1852,  the  season  was 
very  favorable — but  little  sickness  of  any  kind  ;  not  a  case 
of  Trembles  to  the  best  of  my  knowledge.  In  1853-4, 
very  dry  ;  good  health.  In  1855,  rainy  and  hot ;  cholera 
in  Shelbyville  ;  dysentery,  malarial  fevers,  and  Milk  Sick- 
ness in  great  profusion.  In  1856-7,  drouth,  and  good 
health,  except  on  the  border  country  of  the  Kaskaskia  ; 
malaria  and  dysentery  the  scourge.  In  1858,  very  wet,  with 
a  fearful  outbreaking  of  Milk  Sickness.  I  only  speak  for 
this  county. 

I  readily  concede  the  fact  that  my  observations  have 
been  too  limited  and  circumscribed ;  but  straws  show  which 
way  the  wind  blows. 

Again,  it  has  been  rumored  that  it  disappears  at  the 
approach  of  winter,  or  after  the  vegetation  is  destroyed  by 
autumnal  frosts  and  freezings.      This   may  all  be  true  — 


10  Ihe  Peninsular  and  Independent. 

tliat  is,  primary  Milk  Sickness,  or  the  exciting  cause  ;  but 
that  it  lingers  in  the  system,  fermenting,  hibernating,  or 
incubating  (probably  acts  by  catalysis),  as  the  case  may 
be,  and  manifests  itself  in  the  heart  of  winter,  is  a  fact  now 
proven  indubitably  to  me.  Since  Dec.  1st  I  have  treated 
^NQ  well  defined  and  malignant  cases,  and  have  now  (Feb. 
21st)  a  case  under  treatment,  in  this  town.  The  patient 
is  a  road  hand.  When  and  how  the  poison  was  taken  is 
unknown,  but  in  all  probability  from  beef  consumed  last 
fall,  as  the  landlady  at  his  boarding-house  had  a  severe 
attack  in  October  last,  relapsed  in  December,  but  under 
treatment  as  given  in  my  last  communication  to  you  (viz. 
saline  cathartics,  opiates,  tonics,  and  stimulants)  she  re- 
covered. I  would  remark  my  present  patient  is  convales- 
cing finely. 

Let  me  chronicle,  here,  that  many  cattle  died  of  it  in 
the  month  of  December,  1858,  but  none  since,  as  I  have 
learned. 

These  facts  demonstrate  the  truth  (for  such  it  is)  that 
we  may  look  for  Milk  Sickness  in  winter  as  well  as  in  fall 
practice.  And  now,  Messrs.  Editors,  let  all  who  know  on 
this  subject  speak ;  and  we  will  yet  learn  something  of  its 
latent  etiology. 

Oconee,  Illinois. 


ART.  Ill —Detection  of  Alkaloids. 


By  Henry  Erni,  M.  D. 


MORFHTNE. 

In  my  article  "  upon  the  Employment  of  Strychnine  as  an 
Adulteration  for  Alcoholic  Liquors "  (Dec.  1858)  I  descri- 
bed the  reactions  by  which  strychnine  is  recognized,  and 
pointed  out  the  general  principles  wTiich  have  to  guide  us 


Erni  on  Detection  of  Alkaloids.  11 

in  isolating  any  of  the  alkaloids,  when  mixed  with  food, 
contents  of  stomach,  etc.  (p.  518).  In  referring  back  to 
the  method  devised  by  Stas,  I  propose  to  continue  this 
subject  by  giving  the  chemical  tests  for  tracing  Morphine 
and  its  salts. 

Morphine  occurs  in  small,  colorless  prisms,  or  as  a  crys- 
talline powder.  Cold  water  dissolves  about  1  -  1000th, 
hot  water  nearly  double  the  quantity,  the  solution  showing 
an  alkaline  reaction  with  litmus.  Morphine  is  more  soluble 
in  alcohol,  especially  if  boiling  hot,  taking  up  1  -  40th  of  its 
weight,  the  greater  portion  separating  again  on  cooling.  It 
is  nearly  insoluble  in  ether  ;  concentrated  liquor  of  potasi^a 
or  soda  dissolve  it  largely,  and  without  any  chemical  change. 
(Narcotine  is  insoluble  in  alkaline  lexivias.) 

Morphine  forms  crystallizing  salts  with  acids  which  are 
soluble  in  alcohol  ;  sulphate,  acetate,  and  muriate  of 
Morphine  are  also  soluble  in  water,  and  all  of  them  in 
acidulated  water. 

It  is  recognized  by  the  following  reactions  : 

1.  If  we  bring  some  Morphine  into  concentrated 
nitric  acid,  the  latter  assumes  a  blood  red  color,  turning 
gradually  more  and  more  yellow. 

2.  Morphine  and  its  salts  separate  from  a  solution  of 
iodic-acid  free  iodine,  which  is  either  thrown  down  or 
remains  dissolved,  coloring  the  liquid  yellow  to  brown,  and 
exhibiting  its  peculiar  odor  and  turning  starch -paste  blue. 

3.  A  trace  of  Morphine,  dissolved  in  water  slightly 
acidulated  with  muriatic  acid  (the  solution  must  be  as 
neutral  as  possible),  and  brought  in  contact  with  diluted 
(neutral)  perchloride  of  iron,  causes  a  transient  blue  color, 
passing  into  green  and  brown. 

4.  Perchloride  of  platinum  precipitates  salts  of  Mor- 
phine, orange  -  colored  (no  ammonia  or  alkalies  must  be 
present). 

To  establish  the  presence  of  opium,  it  is  but  necessary 
to  trace  the  meconic  acid,  since  it  is  found  nowhere  else. 


12  The  Peninsular  and  Independent. 

The  substance  to  be  examined  is  treated  with  alcohol 
and  a  few  drops  of  chlorohydric  acid  ;  the  extract  is  evapora- 
ted, and  the  residue  mixed  with  some  water  ;  the  insoluble 
portion  is  now  filtered  ofP,  and  the  filtrate  boiled  with  an 
excess  of  caustic  magnesia  {^Magnesia  usta).  We  again 
throw  the  mixture  upon  a  filter,  the  filtered  liquid  contains 
meconate  of  Magnesia,  which,  when  first  acidulated  with 
chlorohydric  acid,  and  brought  together  with  a  solution  of 
perchloride  of  iron,  produces  an  intense  mahogany-brown 
color. 


•  •  • 


ART.  lY.— Cannabis  Indica. 


By  John  M.  Alden,  M.  D. 


From  hearing,  some  years  since,  favorable  reports  relative 
to  the  use  of  Cannabis  Indica  in  convulsive  and  other  affec- 
tions, I  was  induced  to  employ  it,  and  have  been  highly 
pleased  with  its  eff'ects  in  nervous  sufferings,  annoyances, 
irregularities,  and  also  in  nervous  debility. 

In  hysteria  I  have  found  nothing  better.  I  usually  give 
half- grain  doses  of  the  Extract  every  half  hour,  in  pill  or 
alcoholic  solution.  I  prefer  the  latter  form,  as  the  effect  is 
the  more  immediate.      The  formulae  is  as  follows  : 

Ext.  Cannabis  Indicae,  3j. 
Alcohol,  I  iij. 
M.     Dose,  Half  teaspoonfal  every  half  hour. 

I  have  employed  it  in  many  cases  of  delirium  tremens 
with  the  best  results  :  giving  one  -  grain  dose  every  half  hour ; 
which  should  be  continued  until  sleep  is  induced.  I  have 
often  given  twenty  grains  before  this  was  accomplished. 

I  have  also  used  it  with  marked  success  in  cases  of 
palpitation  of  the  heart,  unconnected  with  any  change  of 
structure,   but   dependent   upon  some   disordered   condition 


Alden  on   Cannabis  Indica.      ^  13 

of  the  stomachj  or  some  other  slight  cause  deranging  the 
equilibrium  of  the  nervous  system.  In  these  cases  I  often 
find  it  necessary  to  continue  its  use  for  some  weeks,  giving 
it  three  or  four  times  a  day  in  grain  doses. 

I  have  often  prescribed  it  to  relieve  spasms  arising  from 
cholera  morbus  ;  and  have  found  it  successful  in  infantile 
convulsions,  independent  of  any  vascular  disturbance,  pain- 
ful dentition,  or  cerebral  implication,  but  v^rhich  are  excited 
and  sustained  by  intestinal  irritation,  caused  by  crude  in- 
gesta  or  vitiated  secretions.  Also,  in  severe  cases  of  burns, 
where  the  pain  was  intense,  the  patient  has  derived  much 
benefit  from  it  in  a  short  time.  Its  effects  being  soothing, 
I  think  it  the  best  remedy  in  all  like  circumstances.  I 
have  met  with  most  success  by  the  use  of  this  remedy  in 
cases  of  nervous  headache,  than  from  all  the  other  reme- 
dies combined,  including  caffein  ;  giving  one  grain  of  the 
Extract  every  three  hours  until  the  patient  is  relieved ;  usu- 
ally continuing  it  several  days,  once  in  six  hours,  which 
continuation  intercepts  a  recurring  paroxysm. 

The  only  bad  effects  which  I  have  ever  experienced  from 
its  use,  during  twelve  years'  experience  with  it,  was  in  two 
instances  where  three -grain  doses  were  administered  in  cases 
of  indigestion  and  constipation.  The  first  case  was  that 
of  Mr.  CooPEK,  /in  the  locality  of  Grand  Kapids,  Mich.; 
he  was  of  ordinary  health,  and  I  had  prescribed  the  Ex- 
tract of  Apocynum  Cannahinum  in  three -grain  doses.  The 
druggist,  by  mistake,  put  up  the  Cannabis  Indica ;  the 
mistake  arising  from  the  fact  that  both  articles  are  im- 
properly denominated  Indian  Hemp.  The  nearest  physician 
being  a  Homoeopathist,  he  was  called  in  at  the  time  Mr. 
C.  was  under  the  influence  of  an  overdose  of  this  elixir  vita?, 
which  afforded  him  a  capital  opportunity  to  portray  the 
dangerous  treatment  of  the  regular  practice.  However, 
when  the  facts  were  known  in  the  case,  both  he  and  the 
patient  were  disposed   to  reverse   their  decision,   and  attri- 


14  The  Peninsular  and  Independent. 

bute  the  phenomena  produced  to  the  true  cause.  The 
symptoms  in  this  case  were  of  a  spasmodic  and  convulsive 
character,  very  nearly  allied  to  those  of  tetanus — cramping 
of  the  voluntary  muscles,  at  times  of  the  whole  body.  The 
exacerbations  of  the  spasms  were  very  short,  and  became  less 
frequent,  and  shortly  disappeared  entirely.  There  was  no 
nausea,  but  a  highly  stimulating  effect  was  produced. 

The  second  case  was  Mrs.  B.,  of  this  city  ;  the  same 
prescription  being  ordered  as  in  the  other  instance,  and  the 
druggist  putting  up  the  Cannabis  Indica  by  mistake. 
About  the  same  phenomena  were  produced  as  in  the  first 
case.  When  I  interrogated  her  in  reference  to  her  feelings, 
she  remarked,  laughing  at  the  same  time,  that  she  never 
was  drunk  in  her  life,  but  from  what  she  had  seen  she 
could  not  describe  her  feelings  better  than  to  say  she  was 
^'  very  drunks  The  neighbors  were  much  alarmed,  as  the 
change  was  sudden,  and  the  patient  convalescing  at  the 
time.  By  the  administration  of  an  anti- spasmodic,  she 
soon  recovered  from  its  effects. 

From  my  own  experience  in  the  use  of  the  Extract 
of  Cannabis  Indica,  I  conclude  its  properties  are  stimulant, 
anodyne,  narcotic,  anti  -  convulsive,  anti  -  spasmodic,  and 
aphrodisiac  —  exhilarating  the  spirits,  increasing  the  appe- 
tite, and  in  large  doses,  occasioning  intoxication ;  when 
administered  properly,  restoring  nervous  composure  and 
quietude,  without  impairing  the  appetite,  checking  secre- 
tions, or  constipating  the  bowels,  hence  its  advantage  over 
opium. 


•  •  > 


ART.  v.— A  Case  of  Brain  Disease  presenting  some  Points  of  Interest. 

By  0.  0.  GiBBS,  M.  D. 

There  are  are  some  brain  affections  that  are  so  obscure  in 
their  systemic  manifestations,  that  a  correct  diagnosis  is  by 


GiBBS's   Case  of  Brain  Disease.  15 

no  means  easy.  Tumors,  cysts,  hydatids,  and  tubercles  of 
the  brain,  atrophy  and  softening  of  that  organ,  present 
^occasionally  illustrative  cases.  There  is  one  source  of  con- 
solation to  the  physician  in  these  obscure  cases,  for  it  is 
often  a  matter  of  but  little  moment  whether  our  diagnosis 
be  correct  or  not,  as  they  tend,  generally,  steadily  to  a 
fatal  termination. 

The  following  case  presents  some  points  of  interest : 
January  10th,    1859,  I  was  called   to  see  Mr.  E.,  aged 
about  55  years.      He  was  a  large,  muscular   man,  in  good 
ilesh,  and,  so  far  as  the  digestive  and  assimulative  organs 
were  concerned,  seemed  in  good  health.      He  had,  for  most 
'of  his  life,   been  a  regular   drinker  of  intoxicating  drinks, 
an    immoderate    chewer    of   tobacco,    and   a    hard    laborer. 
When  the  gold   excitement   in  California  was  at  the   first 
height  of  its  rage,  he  went  there,  and  labored  industriously 
for  about  three  years  in  the  mines.      For  the  last  year  his 
family  had  discovered  something  wrong  with  him.      Always 
seemingly  happy,  joyous,    and   mirthful,   he  first   attracted 
'^.ttention  by  telling  foolish  and   laughably  absurd   stories, 
;always  with    seeming  sincerity  and  unfeigned   truthfulness. 
His  memory,  also,  seemed   greatly  impaired,  as   he  would 
tell  the  same  stories  to  the  same  individuals  repeatedly,  and 
never  show   that  he  did   not  suppose  they  were  each  time 
new   to  them.      About   three  months  ago,  the   integrity  of 
the  will   seemed  greatly  impaired.      When  a  certain   labor 
was  commenced  he  seemed   to  have  no  power  to  stop  the 
muscular  exercise  which  that  labor  called  forth.      If  he  went 
to  the  barn  to  throw  down  a  forkful  of  hay  for  his  horse, 
iie  would  never  stop  pitching  down  hay  until  the  whole  mow 
was  upon  the  fioor,  unless  some  one  stopped  him.      If  sent 
out  to  bring  a  handful  of  wood,  he  would  never  stop  until 
the  pile  was  all  in,  or  the  room  was  full,  until  some  one, 
by  force,  put  his  automatic  motions  to  a  stop.      When  he 
onee  commenced  eating,  it  would  seem  as  though  he  would 
never  stop,  unless  forced  to  do  so. 


16  The  Peninsular  and  Independent. 

For  a  few  weeks  past  the  integrity  of  his  mental  oper- 
ations had  seemed  more  disturbed ;  he  seemed  to  lose  the 
power  of  balancing.  When  he  arose  to  an  erect  position 
he  would  commence  to  go  backwards,  and  would  continue 
to  do  so  until  he  fell,  unless  watched  and  brought  down 
upon  a  seat.  When  sitting  he  would  commence  leaning 
backwards,  and  continue  until  he  tipped  over,  unless  pre- 
vented by  his  attendants.  He  was  disposed  to  sleep  much 
and  soundly.  He  was  uniformly  polite,  cheerful,  sometimes 
witty,  and  never  disconcerted,  or  in  any  way  disturbed  by 
any  mishaps  that  befel  him  in  consequence  of  his  loss  of 
balancing  power. 

The  case  was  diagnosed  as  one  of  softening  of  the  brain, 
more  particularly  of  the  cerebellum,  and  a  fatal  issue  was 
prognosticated. 

Though  there  was  no  pain  in  the  head,  the  temples 
were  cupped,  and  a  seton  was  inserted  in  the  back  of  the 
neck.  At  first  small  doses  of  mercurials  with  antimony 
was  given,  but  subsequently  quinine  with  alcoholic  stimu- 
lants were  substituted.  The  patient  gradually  failed,  and, 
without  marked  symptoms,  died  about  two  months  later. 
No  opportunities  for  post-mortem  could  be  had,  much  to 
our  regret. 

Frewsbury,  Chautauque  Co.,  N.  Y. 


Horton's  Meteorological  Register  for  February.         1 7 


ART.  VI.  —  Meteorological  Register  for  Month  of  February,  1859, 


By  L.  S.  Horton,  House  Physician  to  U.  S.  Marine  Hospital. 


Altitude  of  Barometer  above  the  level  of  the  sea,  597  feet.     Latitude,  42«24'N.;   and 
Longitude,  82''58' W.  of  Greenwich. 


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Vol.  II.  ~  B. 


iibIi0Sira5l]ital  llU0rh 


•  •  • 


FAVORITE    PRESCRIPTIONS    OF  LIVING    AMERICAN    PRACTI- 
TIONERS.    By  Horace  Green,  M.  D. 

A  SMALL  work,  giving,  under  appropriate  heads,  the  selec- 
tions from  Favorite  Prescriptions,  amassed  by  Dr.  Green  in 
his  professional  and  social  intercourse  with  those  Practi- 
tioners who  have  visited  him  during  many  years  past. 
Portions  of  these  have  been  quite  extensively  copied  from 
the  American  Medical  Monthly,  in  which  they  have  ap- 
peared, and  from  them  the  reader  can  gather  an  idea  of 
the  whole.      The  author  says : 

"The  publication  of  these  tried  formulae,  with  appended  observa- 
tions—  which  are  the  contributions  of  many  of  the  distinguished  Prac- 
titioners of  our  country  —  will  not  fail,  it  is  believed,  to  add  to  our 
stock  of  knowledge  in  both  rational  therapeutics  and  practical  medicine. 
To  the  young  and  inexperienced  Practitioner  it  will  afford  material  aid." 

THE   KNICKERBOCKER. 

We  received  from  the  Publishers  the  February  ISTo.  of  this 
^'Century  Plant"  among  the  "mushrooms"  of  popular  pe- 
riodical literature. 

We  particularly  noted  an  article  entitled  "A  Grain  of 
Wheat  in  a  Bushel  of  Chaff,"  in  which  the  writer  offers 
ample  proof  that  the  credit  for  priority  in  discovery  of  the 
pain- conquering  power  of  ether  as  an  anaesthetic,  should 
be  awarded  to  Horace  Wells,  of  Hartford,  Conn.,  instead 
of  to   Dr.    Morton,    of    Boston,   who   has   so    strenuously 


Bibliographical  Record.  19 

tjlaimed  it.  To  not  know  ^^  Knich."  is  to  lose  much  that 
is  pithy,  witty,  and  wise ;  and  if  we  confess  to  past  igno- 
rance, it  is  but  to  assure  ourselves  that  in  future  we  shall 
keep  posted. 

JOURNALS  AND  PAMPHLETS. 

1%6  Dental  Reporter.  An  Independent  Journal.  Devoted  to  Dental 
Progress  and  Improvements.  Edited  by  Jno.  T.  Toland.  Feb- 
ruary, 1859. 

The  No.  before  us  contains  an  extended  Eeport  of  the 
meeting  of  the  Michigan  State  Dental  Association,  and 
from  its  contents  generally  we  should  say  it  is  one  of  th© 
most  valuable   of  the  Dental  journals. 

3efw  Surgical  Treatment  for  Malformations  of  the  Urinary  Bladdei\ 
By  Daniel  Ayres,  M.  D.,   LL.  D.      Brooklyn,   N.  Y. 

Y^  Bane  and  Antidote.      By  B.  Frank  Palmer,   of  Philadelphia. 

The  No.  for  January  has  been  received,  together  with 
^  poem  read  before  the  Society  of  the  Sons  of  New 
England,  in  Pennsylvania.  Mr.  Palmek  seems  to  be  as 
much  of  a  genius  in  the  higher  walks  of  literature  as  he  is 
those  of  art.      Success  to  him  ! 

An  Address  to  the  Graduates  of  the  Ohio  College  of  Dental  Surgery^ 
by  W.  W.  Allport,  D.  D.  S. 

An  exceedingly  well  written  paper,  and  worthy  the 
perusal  of  all  dentists  who  have  not  a  clear  idea  of  what 
the  true  status  of  their  Profession  is. 


^Ht0rial  g^prtmtnt. 


Palmer's  Artificial  Limbs. 

During  our  connection  with  the  Medical  Independent 
we  had  occasion  to  speak  in  terms  of  deserved  praise  of 
Palmer's  artificial  leg ;  and  at  that  time  we  also  were  en- 
abled to  state  that  he  had  just  then  completed  an  inven- 
tion of  an  artificial  arm  which  was  surprisingly  perfect  in 
its  action,  and  also  in  resemblance  to  the  form  and  motion 
of  the  natural  organ. 

We  have  no  disposition  to  consume  either  time  or  space 
in  praising  the  ingenuity  manifested  by  Mr.  Palmer  :  that 
is,  at  this  time,  uncalled  for.  He  is  really  a  public  bene- 
factor, and  the  thousands  who  need  his  aid  are  those,  only, 
who  can  suitably  speak  his  praise.  There  is,  however,  one 
result  of  the  invention  to  which  we  would  especially  allude  : 
it  is  the  influence  that  it  has  exerted  upon  the  place  of 
election  in  amputation  of  the  leg.  Formerly,  if  any  por- 
tion of  the  leg  was  to  be  sacrificed,  the  rule  was  to  make 
the  section  as  close  to  the  knee  joint  as  practicable,  inas- 
much as  the  subcutaneous  position  of  the  tibia  prevented 
the  formation  of  a  flap,  or  cushion,  sufficiently  protective 
to  admit  the  adjustment  of  the  artificial  limb  ;  but,  thanks 
to  the  skill  of  Mr.  Palmer,  that  rule  is  now  expunged, 
and  the  conservative  element  of  Surgery,  which  calls  for 
the  utmost  salvation,  can  be  universally  heeded.  The  rule 
is  now  reversed,  and  the  farthest  point  possible  from  the 
knee  joint   is   the   place   for   the   section.      Thus,   all   the 


Editorial  Department. 


21 


advantages    of  a   natural  joint   at   the   knee   are  saved   to 
the  patient. 

Below  may  be  found  a  detailed  description  of  the  leg, 
illustrated  by  wood  cuts  : 

The  articulations  of  knee,  ankle,  and  toes  consist  of  detached  ball- 
and-socket  joints,  J,  B,  G.  The  knee  and  ankle  are  articulated  bj 
means  of  the  steel  bolts,  E,  E,  combining  with  plates  of  steel  firmly 
riveted  to  the  sides  of  the  leg,  J9,  D.  To 
these  side  plates  are  immovably  fastened 
the  steel  bolts,  E^  E.  The  bolts  take  bear- 
ings in  solid  wood  (properly  bushed)  across 
the  entire  diameter  of  the  htiee  and  anTcle^ 
being  fourfold  more  reliable  and  durable 
than  those  of  the  usual  construction.  All 
the  joints  are  so  constructed  that  no  two 
pieces  of  metal  mom  against  each  other  in 
the  entire  limb.  The  contact  of  all  broad 
surfaces  is  avoided  where  motion  is  re- 
quired, and  thus  friction  is  reduced  to  the 
lowest  degree  possible.  These  joints  often 
perform  many  months  without  need  of  oil, 
or  other  attention,  a  desideratum  fully  ap- 
preciated by  the  wearer. 

The  Tendo  Achillis,  or  heel  tendon,  F, 
perfectly  imitates  the  natural  one.  It  is 
attached  to  the  bridge,  6^,  in  the  thigh,  and 
passing  down  on  the  back  side  of  the  knee 
bolt,  E,  is  firmly  fastened  to  the  heel.  It 
acts  through  the  knee  bolt,  on  a  centre^ 
when  the  weight  is  on  the  leg,  imparting 
security  and  firmness  to  the  knee  and  ankle 
joints,  thus  obviating  all  necesssity  for 
knee-catches.  When  the  knee  bends  in  tak- 
ing a  step,  this  tendon  vibrates  from  the 
knee  bolt  to  the  back  side  of  the  thigh, 
A,  Fig.  2,  next  page.  It  descends  through 
the  leg,  so  as  to  allow  the  foot  to  rise 
above  all  obstructions,  in  flexion,  and  car- 
ries the  foot  down  again,  in  extension  of 
the  leg  for  the  next  step,  so  as  to  take  a  firm  support  on  the  ball  of 
the  foot.  Nature -like  elasticity  is  thus  attained,  and  all  thumping 
sounds  are  avoided. 

Another  tendon,  M,  of  great  strength  and  slight  elasticity,  arrests 
the  motion  of  the  knee,   gently,  in  walking,  thus   preventing  all   dis- 


Fig.  1. 


22 


The  Peninsular  and  Independent. 


agreeable  sound  and  jarring  sensation,  and  giving  requisite  elasticity  to^ 
the  knee. 

A  spring,  lever,  and  tendon,  /,  /,  JT,  combining  with  the  knee 
bolt,  give  instant  extension  to  the  leg  when  it  is  semi -flexed  to  take  a., 
step,  and  admit  of  perfect  flexion  in  sitting. 

A  spring  and  tendons  in  the  foot,  X,  if,  N,  impart  proper  and  re- 
liable action  to  the  ankle  joint  and  toes.  The  sole  of  the  foot  is  made 
soft,  to  insure  lightness  and  elasticity  of  step. 

The  stump  receives  no  weight  on  the  end,  and  is  well  covered  and 
protected,  to  avoid  friction  and  excoriation. 

These  joints,  springs,  and  tendons  are  all  patented,  and  no  modifi- 
cation of  any  part  will  enable  a  person  successfully  to  evade  the  patents^ 
which  contain  about  twenty  distinct  and  combined  claims,  eoverin^ 
nearly  the  entire  mechanism. 


Fig.  2. 


JEditorial  Department, 
Fig.  S  is  a  yiew  of  Palmer's  perfect  model  Artificial  Leg. 


2S 


Fig.  S. 

An  artificial  arm,  that  would  be  something  more  than 
ornamental — that  would  serve  useful  purposes,  and  enable 
the  patient  to  grasp  objects  with  tolerable  precision  has 
long  been  a  desideratum.  That  desired  object  has  at  length 
been  realized.  The  same  genius,  directing  the  same  perse- 
vering effort  which  produced  the  incomparable  leg,  has  now 
achieved  a  still  greater  triumph.  Mechanical  perfection  has 
always  challenged  our  warmest  admiration,  but  when  that 
mechanism  is  made  to  supply  the  place  and  motions  of  a 


24  The,  Peninsular  and  Independent. 

lost  human  hand,  even  though  imperfectly,  admiration 
gives  place  to  enthusiasm,  and,  as  a  surgeon,  we  respect- 
fully and  thankfully  salute  the  genius  that  mitigates  the 
evils  necessarily  caused  by  our  reluctant,  though  limb- sac- 
rificing, catlin. 

That  our  readers  may  justly  comprehend  this  useful 
invention  we  insert  the  following  cuts  and  description  : 

Fig.  1,  represents  an  arm  to  be  applied  above  the  elbow.  The  articu- 
lation A  B,  is  a  ball  and  socket,  connected  by  the  steel  plates  G  c,  and 
turning  upon  the  pinion  D.  The  functions  of  the  bones  in  the  Fore -arm 
(Radius  and  Ulna),  are  imitated  by  the  conical  shaft  E,  which  termi- 
nates in  a  ball  at  the  elbow  and  wrist  J"/.  The  wrist  is  articulated  with 
a  ball  and  socket  firmly  united  by  catgut  tendons  F^  (?,  H^  tensely  drawn 
over  the  convexity  of  the  shaft  E  at  the  elbow.  It  has  every  motion 
of  the  natural  wrist.  The  hand  rotates  on  the  Fore -arm,  being  suscep- 
tible of  pronation  and  supination,  or  any  angle  or  degree  of  flexion  and 
extension  desirable.  The  extensor  tendons  K^  Z,  if,  N,  0,  acting  with  the 
springs  1,  2,  3,  4,  5,  open  the  hand.  The  detached  ball  and  socket 
joints  of  the  thumb  and  fingers  are  indicated  by  the  figures  1,  2,  and 
1,  2,  8. 

The  fingers  are  articulated  on  steel  rods  and  pinions  imitating  the 
bones,  as  seen  in  the  thumb  and  the  first  and  third  fingers.  The  exte- 
rior is  brought  to  a  perfect  imitation  of  the  natural  arm  (as  shown  in 
the  outline,  or  in  Fig.  5),  by  a  soft  elastic  substance,  which  rotates 
around  the  Fore -arm,  preserving  anatomical  symmetry  in  every  position. 
It  is  covered  with  a  delicate  skin. 

Fig.  2,  is  the  same  arm  extended,  with  the  fingers  semi -flexed. 
The  belt  A  attaches  the  arm  to  the  body.  The  small  belt  G  G'2i^  is 
connected  by  a  tendon  to  a  clasp  and  pulley  D^  E.  The  great  muscle 
F  is  the  continuity  of  the  flexor  tendons  G,  H^  /,  /,  K.  These  tendons 
pass  sinuously  over  pulleys  or  fixed  sheaves,  1,  2,  3,  4,  5,  through  the 
hand,  to  the  end  of  the  fingers  and  thumb.  The  principles  of  the  lever 
and  pulley  are  thus  combined,  and  the  maximum  power  retained  at  all 
angles  of  flexion  or  extension.  A  slight  motion  of  the  shoulders,  with 
extension  of  the  Fore -arm,  produces  an  incredible  grasp,  as  seen  in 
Fig.  3. 

An  object  of  any  shape,  such  as  a  pen,  a  fork,  or  an  apple  is  held 
with  facility.  By  a  slight  motion  of  the  shoulders  the  belt  A  B  causes 
the  great  muscle  F,  and  its  tendons,  to  contract  powerfully,  closing  the 
hand.  A  movement  easily  and  naturally  made  actuates  the  tendon  G  6^2 
and  fastens  the  clasp  D  upon  the  muscle  so  as  to  retain  the  grasp  in 
any  position  or  motion  of  the  arm,  when  in  use.  This  is  regarded  as 
invaluable  for  holding  reins  in  driving,  or  carrying  articles  with  safety. 


Editorial  Department. 


25 


26  The  Peninsular  and  Independent, 

An  easy  counter  -  motion  unfastens  the  clasp^  relaxing  the  flexor  muscle 
and  its  tendons,  and  the  extensors  open  the  hand.  This  principle  per- 
forms most  perfectly  in  an  arm  applied  below  the  elbow,  as  in  Fig.  3. 

Fig.  3.  In  this  are  seen  the  belt  A  B  C^  the  great  muscle  F  and 
its  tendons,  the  clasp  and  pulley  i),  E^  as  in  Fig.  2.  A  fixed  eyelet,  j?^2, 
clasps  the  great  muscle  F  and  thus  guides  the  flexor  tendons  of  tho 
fingers.  The  line  1,  shows  the  union  of  the  natural  with  the  artificial 
arm. 

Fig.  4  shows  a  hand  holding  a  fork.  The  tendon  A  A^  pa^ea 
through  the  clasp  B^  and  around  the  pulley  (7,  to  the  side  of  the  clasp  D, 
where  it  fastens  or  unfastens  the  clasp,  by  movements  before  explained. 
The  joints  of  the  fingers  and  thumb  are  flexed  upon  the  fork,  by  powerful 
tension  of  the  great  muscle  and  its  tendons.  The  sinuosity  of  the  tendons 
passing  over  the  pulleys  or  sheaves,  F^  E,  E^  shows  the  new  and  useful 
principle  of  effectually  combining  the  lever  and  pulley  to  gain  the  utmost 
power,  strength,  elasticity  and  adaptaMlity  to  the  various  uses  of  an  ,Ajrti- 
ficial  Arm  and  Hand.     They  are  easily  adjusted  by  the  wearer. 

Q 

Diseases  of  the  Csecnm, 

We  have  repeatedly  been  inquired  of  for  something 
upon  diseases  of  the  cascum.  The  literature  of  this  sub- 
ject is  really  meagre,  and,  as  we  know  of  nothing  recent, 
we  have  reproduced,  from  the  New  York  Journal  of  Med^^ 
icine,  for  July,  1845,  an  article  which  will  amply  repay 
perusal.  It  will  be  found  in  the  department  of  '^Selected 
Articles,  Abstracts,  <&cJ' 

The  Publishers 

Desire  to  call  the  attention  of  the  Profession  in  the 
State  to  their  Catalogue  in  the  Advertising  Department. 
It  has  been  extended  and  revised,  the  prices  being  placed 
at  rates  as  low  as  the  quality  of  goods  offered  can  be  afforded 
in  this  or  any  other  market. 


StlKtjlr  J,rti£hs,  ^bstnds,  ici. 


Cases  IllustratlTe  of  Diseases  of  the  Csecmn  and  its  Appendix. 

By  Edson  Cabr,  M,  D. 

Thb  caecum  has  manifestly  an  individuality  both  of  function  and  dis^- 
ease — having  offices  to  perform  in  some  respects  quite  peculiar  to  itself 
while  it  is  subject  to  frequent  derangements  and  fatal  diseases,  in 
which  no  other  portion  of  the  digestive  apparatus  Is  implicated. 

Wheile  the  former  have  received  far  less  consideration  than  their 
relative  importance  would  seem  to  demand,  the  latter  can  scarcely  be  said 
to  have  a  place  in  our  systematic  practical  works. 

A  Monograph  by  Dr.  John  Buene,  an  article  in  Copeland's  Dic- 
tionary of  Practical  Medicine,  and  the  cases  which  are  detailed  in 
Dupuytren's  Chemical  Lectures,  embrace  nearly  all  that  has  fallen  under 
my  notice  on  this  interesting  class  of  affections,  with  the  exception  of 
single  cases  which  occasionally  appear  scattered  through  our  periodicals. 

If  we  take  but  a  very  superficial  view  of  this  organ,  its  situation 
and  capacity,  its  attachment  to  the  parietes  of  the  abdomen,  so  confining 
it  that  its  relative  position  admits  of  no  change,  and  the  circumstance 
that  its  contents  are  moved  forward  in  opposition  to  the  laws  of  grav- 
itation, it  must  be  evident  that  the  alimentary  substances  were  de- 
signed to  remain  here  longer  than  in  any  other  portion  of  the  alimentary 
canal. 

These  considerations  have  very  naturally  suggested  the  idea  that 
the  caecum  constitutes  a  kind  of  second  stomach. 

Again,  if  we  examine  a  little  more  carefully  into  its  organization, 
we  find  the  caecum  liberally  furnished  with  large  follicular  glands,  evi- 
dently designed  for  the  abundant  secretion  of  important  fluids,  while 
the  entire  organ,  with  its  appendix,  is  more  richly  supplied  with  arte- 
rial blood  than  any  other  portion  of  the  intestinal  canal.  It  appears 
from  the  experiments  Of  Tiedemann  and  Gmelen,  that  these  follicular 
glands  "secrete  an  acid,  albuminous,  and  solvent  fluid,  which  mixes 
with,  and  promotes  the  digestion  of  those  portions  of  aliments  which 
have  withstood  the  action  of  the  stomach  and  small  intestines,  or  hare 
been  insufficiently  changed  by  them."    We   may  also  remark  that  the 


28  The  Peninsular  and  Independent. 

contents  of  the  alimentary  canal  first  acquire  their  peculiar  fecal  odor 
in  the  csecum.  This,  according  to  the  researches  of  the  same  physiolo- 
gists, depends  upon  an  oily  volatile  substance  secreted  by  the  mucous 
follicles.  And  we  think  it  highly  probably  that  the  appendix  performs 
an  important  part  of  this  work,  since,  when  examined  in  its  natural 
condition,  it  is  generally  found  to  contain  a  portion  of  this  material. 
Indeed,  we  think  it  would  be  difficult  to  assign  a  more  probable  func- 
tion to  this  organ ;  inasmuch  as  its  formation  is  such  as  to  preclude 
the  idea  of  the  alimentary  substances  entering  it,  while  the  large  supply 
of  blood  sent  to  it  must  plainly  bespeak  for  it  a  more  important  office 
than  merely  affording  a  convenient  retreat  for  such  unlucky  cherry 
stones  and  the  like,  as  may  chance  to  escape  from  their  destined 
course. 

It  farther  appears  probable  from  the  experiments  of  TiEDiEMANw 
and  Gmelen,  that  the  caecum  performs  the  additional  function  of  secret- 
ing, "chiefly  from  its  numerous  follicles,  an  unctuous  fluid  for  the 
protection  of  the  surfaces  of  the  large  bowels  from  the  irritating  effects 
of  the  fecal  matters  passing  along  them,"  and  that  the  constituents  both  of 
this  and  of  the  other  secretions  poured  out  from  its  surface,  consist  of 
elements  which  require  to  be  eliminated  from  the  blood;  so  that,  in 
addition  to  its  other  functions,  it  is  also  a  depurating  organ. 

We  may  reasonably  infer  from  the  foregoing  considerations  that 
the  caecum  is  an  important  organ,  whose  functions  can  neither  be  sus- 
pended nor  suffer  material  derangement,  without  serious  detriment  to 
the  animal  economy. 

My  own  observations  lead  me  to  apprehend  that  such  disturb- 
ances occur  much  more  frequently  than  it  has  generally  been  supposed. 
Such  suspension  or  modified  function  may  result  from  various  causes, 
as  defective  nervous  stimuli,  the  unnatural  stimulus  of  crude,  undi- 
gested food,  unhealthy  secretions  of  the  prima  via,  or  sympathetic  re- 
lation with  some  other  organ,  in  a  pathological  condition.  The  following 
case  will  perhaps  sufficiently  illustrate  the  most  simple  form  of  such 
derangement : 

Case  I.  Mrs.  B.,  now  thirty -seven  years  of  age,  experienced  slight 
inconvenience  early  in  the  summer  of  1828,  from  dyspeptic  symptoms, 
which  readily  subsided  under  a  regulated  diet.  From  early  childhood 
to  that  period,  she  had  never  suffered  from  any  serious  indisposition. 
She  soon  lost  her  ruddy  complexion,  her  usual  elasticity  and  strength 
began  to  decline,  her  lips  and  tongue  became  pale,  and  a  general  dis- 
inclination to  physical  and  mental  exertion  soon  followed.  But  the 
more  remarkable  circumstances  manifested  in  this  case,  are  a  slight 
uneasiness  seldom  amounting  to  pain,  frequently  felt  in  the  region  of 
the  caecum,  and  ascending  colon,  attended  with  an  evolution  of  gas 
which  escapes   entirely  without  odor,   while   the  fecal  matters,   which 


Selected  Articles^  Abstracts^  dc.  29 

are  quite  natural  in  appearance,  with  the  exception  of  perhaps  being 
slightly  softer  than  common,  are  generally  entirely  wanting  in  fecal 
odor. 

This  state  of  things  has  continued  with  but  short  intervals  of 
interruption  for  more  than  sixteen  years.  During  this  period  she  has 
had  a  good  appetite,  with  no  unnatural  thirst,  and  daily  motions  of 
the  bowels  without  the  use  of  medicine.  This  uterine  functions  have 
been  uniformly  healthy.  She  has  borne  four  children  during  the  time. 
Menstruation  has  never  been  interrupted  except  during  pregnancy  and 
nursing.  It  has  never  varied  materially  in  time,  quantity,  or  quality, 
and  has  never  been  attended  with  pain  or  any  appreciable  constitu- 
tional disturbance.  She  has  never  suffered  from  leucorrhoea,  or  indeed 
from  any  other  indisposition  than  the  above  described. 

Several  intelligent  members  of  the  Profession  have  been  consulted 
in  this  case,  and  the  functions  of  every  organ  in  the  body  have 
been  faithfully  interrogated  and  carefully  watched,  and  yet  no  one 
has  been  able  to  form  a  satisfactory  opinion  as  to  the  cause  of  these 
peculiar  phenomena. 

The  observations  of  Dr.  Copland  upon  the  functional  derangements 
of  the  caecum,  seems  to  throw  some  light  upon  this  and  similar  cases, 
and  make  it  appear  at  least  probable  that  these  peculiarities  depend 
on  such  derangement.  If  the  views  which  are  entertained  in  regard 
to  the  functions  of  the  cascum  be  correct,  there  will  be  no  diflBulty 
in  coming  to  such  conclusion. 

I  might  here  introduce  several  other  cases  which  would  seem  to 
confirm  the  correctness  of  the  views  above  presented,  but  perhaps 
this  may  be  sufficient  to  direct  the  attention  of  other  and  more  com- 
petent inquirers  to  its  investigation. 

I  will,  however,  remark,  that  I  had  an  opportunity,  about  a  year 
since,  of  making  an  examination  of  a  case  in  which  the  leading  symp- 
toms had  for  a  long  time  been  similar  to  the  one  already  described. 
In  this  instance,  death  was  occasioned  by  the  sudden  supervention  of 
acute  gastro  -  enteritis.  The  lower  part  of  the  ilium,  the  caecum,  and 
'a  small  part  of  the  ascending  colon  were  found  very  much  hypertro- 
phied,  the  parietes  of  the  caecum  measuring  over  two  lines  in  thick- 
ness, while  the  cavity  of  the  appendix  was  so  nearly  obliterated  a^ 
barely  to  allow  the  introduction  of  a  small  probe. 

Dr.  Copland  remarks,  that  "when  the  vital  energies  are  weakened 
and  the  alimentary  canal  debilitated,  the  caecum  often  betrays  greater 
disorder  than  any  other  part  of  the  digestive  system.  Its  situation 
and  functions  will  account  for  the  frequency  and  importance  of  its 
diseases.  In  some  cases  the  irritation  produced  by  morbid  or  accu- 
mulated matters  in  it  are  slight,  and  readily  productive  of  suJEcient 
reaction   of   its    muscular   coats   to  propel    them    along  the   colon:    in 


30  The  Peninsular  and  Independent. 

other  instances,  the  efforts  made  to  accomplish  this  end,  owing  to  the 
obstructions  occasioned  by  the  lodgment  of  flatus  about  the  right 
flexure  of  the  colon,  or  by  irregular  spasmodic  contractions  of  this 
bowel,  are  ineffectual,  and  give  rise  to  colicky  pains.  If  the  inter- 
ruption is  removed,  disorder  soon  subsides ;  but  if  it  continues  for 
any  considerable  time,  the  more  violent  forms  of  colic  or  ileus  super- 
vene." 

The  two  following  cases,  while  they  corroborate  the  foregoing  re- 
marks, have  some  points  of  peculiar  interest  as  illustrating  the  fact^ 
that  the  bowels  may  be  freely  evacuated  with  active  cathartic  medi- 
cine, while  substances  remain  impacted  in  the  caacum  undisturbed. 

Case  II.  On  the  7th  Aug.,  1835,  I  visited  Sauger  Brockelbank, 
a  lad  thirteen  years  old,  who  had  complained  for  two  or  three  days 
with  colicky  pains.  He  had  taken  salts,  castor  oil,  and  cathartic  pills, 
which  had  operated  well,  but  without  relieving  the  pain. 

I  learned  that  four  days  previous  to  this  time,  he  had  eaten  freely 
of  choke  cherries  (prunus  virginiana.)  On  examining  the  abdomen,  he 
seized  my  hand  as  it  approached  the  right  iliac  region,  exclaiming  that 
it  was  very  sore.  Careful  examination  discovered  a  distinct  circum- 
scribed fullness  and  hardness  over  the  cascum.  He  complained  of  thirst 
and  headache;  pulse  eighty -four,  and  rather  hard. 

Pres.  V.  s.  I  XV.,  calomel  ten  grs.,  to  follow  in  three  hours,  with 
castor  oil.     Warm  fomentations  to  the  bowels. 

8^^.  His  bowels  have  been  freely  moved  several  times.  Soreness 
over  the  caecum  still  continues;  pulse  ninety -two,  v.  s.  repeated;  cal- 
omel four  grs.,  with  one -eighth  gr.  morphine  to  be  repeated  every  six 
hours.     Blister  to  the  seat  of  the  soreness. 

^th.  Bowels  have  not  been  moved  since  yesterday;  pulse  ninety- 
two;  tongue  slightly  coated  with  white  creamy  covering;  pres.  calomel 
five  grs.,  to  be  followed  with  castor  oil  in  four  hours.  Blister  to  be 
dressed  with  warm  poultice  of  slippery  elm. 

10^^.  Soreness  j-ather  increased ;  bowels  moved,  but  slightly ;  pulse 
ninety -four,  small  and  quick;  pres.  calomel  and  Dover's  powder,  each 
three  grs.  every  four  hours,  and  fomentations  to  the  bowels. 

Wth.  Has  had  two  slight  motions  of  the  bowels — without  faecal 
odor.  Calomel  and  Dover's  powders  continued;  blister  renewed,  and 
to  be  dressed  with  slippery  elm  poultice. 

E'Gening.  His  bowels  have  been  moved  several  times  during  the  day ; 
no  faecal  odor;  complains  of  thirst,  tongue  heavily  coated  but  not 
dark ;  five  grs.  of  Dover's  powder  every  four  hours. 

llth.  Relieved  from  pain  by  Dover's  powder,  but  not  otherwise 
improved;  calomel  and  Dover's  powders  eyery  four  hours,  blister  re- 
newed. 

IZth,  Tongue   more    thickly   coated;   pulse   ninety -six;   small  and 


Selected  Articles^  Abstracts^  cbc.  3l 

quick;  pres.  calomel  five  grs,,  to  be  followed  in  three  hours  with  salts 
and  senna,  and  in  three  hours  the  following  enema  to  be  administered : 
^.  Castor  oil  |  ij.,  spts.  terebinth  |j.,  warm  water  one  pint. 

Evening.  The  bowels  have  moved  freely  several  times  during  the 
day.  The  evacuations  contained  what  the  mother  termed  "a  handful 
of  cherry  stones,  which  had  remained  so  long  that  they  smelt  very 

bad." 

From  this  time  the  soreness  began  to  subside,  and  his  recovery 
was  rapid  and  uninterrupted. 

Can  there  be  any  doubt  that  in  this  case,  the  cherry  stones  were 
lodged  in  the  caecum  during  the  nine  days  which  intervened  between 
the  time  of  eating  and  discharging  them  ? 

Case  III.  At  1  a.  m.,  August  17,  1840,  I  was  called  to  R.  B.  aged 
20.  He  complained  of  excruciating  pain  in  the  abdomen,  with  nausea, 
retching,  anxious  countenance,  features  much  contracted,  pulse  110 
quick,  small  and  tense;  the  whole  abdomen  extremely  painful  to  the 
touch.  He  had  been  troubled  for  several  days  with  diarrhoea,  attended 
with  occasional  griping  pains.  For  the  last  twenty -four  hours,  he 
had  felt  a  dull  aching  pain  in  the  bowels,  which  was  increased 
while  in  the  erect  posture,  and  greatly  aggravated  by  any  slight  jar, 
as  in  walking.  But  the  severe  pain  came  on  suddenly  on  rising  from 
his  bed  just  before  I  was  called,  at  which  time  he  experienced  a  small 
chill.  I  took  from  the  arm  thirty -six  ounces  of  blood,  gave  him  fif- 
teen grains  of  calomel  combined  with  one -half  grain  of  morphine,  and 
hot  fomentations  were  applied  to  the  bowels. 

6  A.  M.  Pain  and  nausea  slightly  relieved,  but  the  soreness 
■of  the  bowels  continued.  Bleeding  repeated  to  twenty  ounces,  which 
occasioned  fainting;  calomel  ten  grs.  and  morphine  one -half  gr. ;  fomen^ 
tations  continued,  and  a  mixture  of  calc.  magnesia  3  ij.,  aromat.  syrup  of 
rhubarb.  |j.;  to  be  given  in  three  hours. 

2  p.  M.  Pulse  127.  Soft  and  compressible  pain  much  relieved. 
By  means  of  a  flexible  tube  passed  into  the  colon,  the  following  enema 
was  administered:  3.  Castor  oil,  |ij. ;  spts.  turpentine,  |  i. ;  warm 
water,  three  pints.  This  passed  off  in  the  course  of  three  hours,  with 
some  faecal  matter. 

9  p.  M.  Pain  much  diminished  and  entirely  confined  to  the  right 
Iliac  region,  where  a  distinct  circumscribed  fullness  and  hardness  was 
perceptible.  Calomel,  three  grs. ;  morphine,  one  -  fourth  gr. ;  to  be  given 
«very  four  hours. 

l^t\  Morning.  Pain,  soreness  and  swelling  over  the  caecum,  con- 
siderably increased ;  pulse  130,  small  and  quick.  An  injection  of  warm 
water  and  castor  oil  produced  a  small  faecal  evacuation,  without  odor. 
Calomel  and  morphine  continued ;  about  four  oz.  of  blood  was  taken 
from  the  region  of  the  caecum  by  cupping  and  fomentations  to  the  seat 
of  pain. 


32  The  Peninsular  and  Independent. 

,  .,.,   2  p.  M.      Pain   somewhat   relieved ;    blister   applied   to   the   seat  of 
pain. 

9  o'clock^  Eveni7ig.  Pain  much  relieved.  Injection  repeated,  but 
with  slight  effect  —  calomel  3  grs.,  Dov.  powder  4  grs.  to  be  given 
every  four  hours.     Blister  to  be  dressed  with  slippery  elm  poultice. 

19^/i,  Morning.  Rested  well;  free  from  pain;  pulse  120,  soft  and 
compressible.  Tongue  slightly  covered  with  moist  white  fur.  Mixture 
of  castor  oil,  |  j.,  and  an  equal  quantity  of  aromatic  syrup  of  rhubarb? 
to  be  given  directly. 

2  p,  M.  Has  had  rather  a  scanty  evacuation,  tinged  with  bile,  with 
slight  faecal  odor;   feels  much  relieved. 

8  d'cloch^  Evening.  Pulse  110,  soft  and  compressible;  bowels  have 
been  freely  evacuated;  f^cal  odor  strongly  marked.  5  grs.  Dov.  pow- 
ders to  be  given  for  the  night. 

20^A,    Morning.     Has    had    a    tolerable    night's   rest;    pulse    100 
bowels  acted  freely ;  complains  of  soreness,  and  some  deep  seated   pains 
in  the  region  of  the  caecum.     Blister  dressed  with  mercurial   ointment. 

Evening.  Pulse  100;  swelling  and  soreness  still  continues;  cam- 
phor and  opium  pill  to  be  given  at  bed  time.  Mercurial  dressing 
continued. 

2l8t.  Still  complains  of  dull,  deep  -  seated  pain  ;  pulse  100;  camphor 
and  opium  pill;   mercurial  dressings  continued. 

Evening.  Pain  continues ;  pulse  more  full  and  hard ;  tongue  more 
coated,  with  edges  very  red ;  colon  distended  with  |  iv.  castor  oil,  in 
five  pints  warm  water.  This  brought  away  an  apple  seed,  with  some 
flakes  of  hardened  faecal  matter  which  appeared  as  if  broken  from  a 
hard  mass.  Pres.  Dov.  powder  and  cal.  aa  5  grs.  to  be  repeated  every 
four  hours. 

22(Z,  Morning.  Has  had  a  quiet  night;  pulse  100;  tongue  looks 
better;  swelling  and  soreness  much  relieved;  skin  has  been  in  a  moist 
state  during  most  of  the  night.  Has  had  a  large  evacuation  of  offen- 
sive faecal  matter,  with  several  hardened  lumps  in  which  were  found  a 
number  of  whole  unripe  blackberries.  On  inquiry,  no  fruit  of  the  kind 
had  been  taken  since  the  Saturday,  a  week  before  his  illness. 

Evening.  Has  had  several  evacuations  during  the  day,  with  frag- 
ments of  hardened  faecal  matter,  containing  numerous  seeds  of  Ji)lack- 
berry. 

From  this  time  he  began  gradually  to  recover,  although  it  was 
several  weeks  before  the  soreness  and  swelling  had  so  far  subsided  as 
to  allow  of  his  returning  to  business. 

He  has  since  had  several  slight  attacks  of  pain  and  soreness  in 
the  region  of  the  caecum,  from  error  in  diet,  which  have  readily 
yielded  to  prompt  treatment. 

We  may  remark  that  in  both  of  these  cases,  during  the  time  in 
which  foreign   substances   remained   impacted   in   the   cascum,  although 


Selected  Articles^  Abstracts,  <&c.  33 

the  bowels  had  been  repeatedly  freely  acted  upon  by  medicine,  there 
was  an  almost  entire  absence  of  faecal  odor  in  the  alvine  discharges. 
I  have  noticed  the  same  circumstance  in  several  other  similar  cases, 
and  recognized  the  re  -  appearance  of  the  odor,  as  one  of  the  earliest 
symptoms  of  anything  like  permanent  relief 

Case  IV.     On  the  evening  of  the  29th  of  August,  1835,  I  visited 

Miss ,  a   young  lady,    sixteen    years   of  age.     She  had  suffered 

from  slight  headache,  for  two  or  three  days.  Four  days  previous, 
while  walking  in  the  garden,  she  had  taken  several  unripe  plums, 
since  which  time  she  has  had  no  motion  of  the  bowels.  I  attributed 
her  headache  to  this  circumstance,  and  directed  castor  oil,  and  aro" 
matic  syrup  of  rhubarb,  of  each  one  ounce. 

30^A.  She  has  had  no  motion  of  the  bowels:  headache  continues; 
Pres.  15  •  Calc.  magnesia  3j. ;  spts.  ammonia  aromat.,  3j. ;  mint  water, 
I  j. ;  to  be  taken  directly,  and  repeated  in  three  hours  if  required. 

E'cening.  The  medicine  has  had  no  effect;  and  the  following  was 
ordered :  calomel,  8  grs. ;  com.  ext.  colocynth,  12  grs.  j  and  should  this 
have  no  effect,  it  may  be  repeated  in  six  hours. 

31s(5.  Her  medicine  has  had  no  effect;  complains  of  pain  in  the 
bowels.  On  examination,  I  discovered  tenderness  and  slight  fullness  in 
the  right  iliac  fossa.  V.  S.  |  xvj.,  fomentations  to  the  abdomen,  and 
an  enema  to  be  administered  directly,  and  should  there  be  no  mo- 
tion of  the  bowels  in  three  hours,  the  following  mixture  to  be  given : 
Castor  oil,  |  j.,  aromatic  syrup  of  rhubarb,  |  ss.,  with  the  addition  of 
two  drops  of  croton  oil. 

From  this  time  to  the  third  of  September,  being  ten  days  from 
the  time  she  had  taken  the  plums,  although  all  ordinary  means  had 
been  resorted  to,  such  as  bleeding,  blistering,  warm  baths,  enemas 
and  active  cathartics,  no  passage  of  the  bowels  had  been  effected. 

At  the  request  of  Dr.  Bristol,  who  was  now  called  in  consulta- 
tion, the  croton  oil,  warm  bath,  and  enema  were  repeated,  but  all  with 
no  effect. 

Sept.  4tth.  The  soreness  and  pain  have  increased  during  the  night ; 
tongue  loaded  with  a  heavy  white  coat ;  pulse  88,  quick  and  small ; 
calomel  and  Dover's  powders,  each  three  grs.  every  three  hours.  About 
noon  she  experienced  a  smart  chill,  which  was  followed  by  severe 
pain  and  exquisite  tenderness,  which  spread  rapidly  over  the  whole 
abdomen. 

Drs.  Cheney  and  Bristol  were  now  called  in  consultation.  The 
stomach  had  become  so  irritable  as  to  reject  everything  taken  into  it, 
and  the  rectum  so  sensitive,  that  enemas  by  an  ordinary  syringe 
could  not  be  retained,  and  it  was  proposed  to  distend  the  colon  freely 
by  means  of  a  long  flexible  tube.  In  attempting  to  pass  this  into 
the  colon,  I  met  with  a  diflficulty  which  I  had  frequently  encountered 
in  similar  attempts. 

Vol.  TT. -C. 


34  The  Peninsular  and  Independent. 

When  the  tube  reaches  the  angle  which  the  intestine  makes,  in 
passing  over  the  psoas  muscle  and  common  iliac  artery,  it  meets  the 
side  of  the  gut,  nearly  at  a  right  angle,  and  after  forcing  the  intes- 
tine before  it  as  far  as  its  loose  folds  at  this  point  will  allow,  the 
tube  is  doubled  upon  itself,  some  two  or  three  inches  from  its  point, 
and  broken.  That  this  is  the  nature  of  the  difficulty,  which  frequently 
occurs  in  passing  a  flexible  tube  into  the  colon,  I  have  satisfied  my- 
self by  laying  open  the  abdomen  of  the  dead  subject,  and  introduc- 
ing it  with  the  intestine  exposed  to  view.  Indeed,  I  think  it  requires 
especial  good  luck,  as  well  as  dexterous  manosuvering,  to  be  able  in 
all  cases  to  pass  an  elastic  gum  tube  into  the  colon,  although,  from 
the  representations  of  Mr.  O'Beirn  and  some  others,  it  seems  quite 
otherwise. 

In  order  to  satisfy  myself  whether  there  was  any  unnatural  ob- 
struction in  this  case,  I  took  a  common  rectum  sound,  and  passed 
it  into  the .  colon  without  diflBculty.  It  now  occurred  to  me  that  a 
flexible  metallic  tube,  made  in  shape  similar  to  the  sound,  might  be 
introduced  without  trouble,  I  accordingly  prepared  one  the  size  of  a 
large  catheter,  with  an  egg-shaped  bulb  upon  the  end,  pierced  with 
several  holes  like  the  tube  of  the  womb -syringe  —  passed  it  into  the 
colon,  attached  it  to  the  tube  of  the  Reed's  double  valve  pump,  and 
gradually  distended  the  colon  with  a  mixture  of  castor  oil  §  iv.,  spts. 
turpentine  |j.,  and  five  pints  warm  water.  This  soon  passed  off,  and 
with  it  a  large  quantity  of  dark  faecal  matter,  containing  several  balls 
of  black,  hardened  faecal  matter,  about  the  size  and,  in  appearance, 
not  unlike  the  black  walnut.  The  evacuations  were  attended  with 
alarming  fainting,  but  were  soon  followed  by  relief  from  all  pain  and 
threatening  symptoms. 

The  three  preceding  cases,  I  apprehend,  furnish  us  with  exam- 
ples of  the  most  common  causes  of  acute  inflammation  of  the  caecum, 
viz. :  foreign  indigestible  substances,  or  hardened  faecal  matter,  impacted 
in  the  caput  coli. 

Mr.  John  Burne,  Physician  to  the  Westminster  Hospital,  in  an 
article  published  in  the  20th  vol.  of  the  Medico -Chirurgical  Transac- 
tions^ has  given  a  history  of  eight  very  interesting  cases  of  this  dis- 
ease. He  tells  us  he  has  seen  no  less  than  twenty  cases,  in  all  of 
which  he  has  not  seen  a  single  example  of  idiopathic  inflammation  of 
the  csecum  from  the  ordinary  general  causes  —  exposure  to  the  vicis- 
situdes of  weather,  &c,  "But  every  instance  has  been  symptomatic 
of  some  mechanical  exciting  cause,  as  the  lodgment  of  undigested  food, 
of  fruit  stones  or  concretions  which  the  structure  of  the  caacum  and 
appendix  favors;  and  hence  the  peculiar  features  of  the  disease."  It 
not  unfrequently  happens  that  after  an  attack  of  acute  inflammation 
of  the  caecum,  induced  by  some  foreign  substance  impacted  in  its 
cavity,  the  natural  powers  of  the  organ  are  but  slowly  regained ;  hence 


Selected  Articles^  Abstracts^  <jbc.  35 

it  is  subject  to  renewed  attacks  from  any  trifling  error  in  the  diet,  or 
slight  exposure  to  cold.  Such  cases  often  become  exceedingly  trouble- 
some and  difficult  to  manage.  The  following  is  an  instance  of  the 
liability  to  a  recurrence  of  this  kind : 

Case  V.  On  the  evening  of  June  13th,  1843,  Miss  E.  J.  W,, 
aged  17,  was  seized  with  pain  in  the  bpwels,.  which  was  attributed 
to  her  having  eaten  freely  of  unripe  gooseberries  during  the  preceding 
afternoon.  I  saw  her  early  on  the  morning  of  the  14th.  Her  coun- 
tenance was  indicative  of  severe  suffering.  She  had  taken  a  full  dose 
of  Gregory's  Mixture  (magnesia,  rhubarb,  and  ginger),  which  was  re- 
jected. The  pain  was  referred  to  the  umbilical  region;  pulse  88,  full 
and  sharp,  Pres.  V.  S.  |  xx.,  calomel  grs.  10,  morphine  grs.  ^,  hot 
fomentations  to  the   abdomen. 

I  saw  her  again  in  three  hours.  Her  medicine  had  been  re- 
tained, although  there  had  been  some  retching.  Pulse  84,  pain  some- 
what abated.  Pres.  Calomel  grs.  5,  morphine  gr.  3^.  Fomentations 
continued. 

3  p.  M.  She  complains  much  less  of  pain.  Skin  moist;  tongue 
slightly  coated  with  moist  white  fur;  pulse  84,  soft.  Pres.  Half  a 
Seidlitz  powder,  to  be  repeated  every  hour,  in  hot  water.  Fomenta- 
tions to  be  continued. 

9  p.  M.  Medicine  has  been  retained,  but  there  has  been  no  mo- 
tion of  the  bowels.  Slight  pain  still  complained  of  in  the  umbilical 
region.  Abdomen  soft;  moderate  pressure  occasions  no  pain  except 
over  the  caecum,  where  there  is  an  evident  fullness,  quite  tender  to 
the  touch.  Pres.  An  enema  of  castor  oil  and  warm  water,  to  be 
administered  directly.  Calomel  and  Dover's  powder,  each  grs.  iij.,  to 
be  given  every  four  hours.     Fomentations  to  be  continued. 

15th.  She  has  passed  a  comfortable  night;  had  a  slight  motion 
of  the  bowels  soon  after  the  enema,  with  some  dark  fsecal  matter. 
The  pain  has  entirely  receded  to  the  right  iliac  foss,  where  it  now  re- 
mains constant  but  not  severe.  Soreness  not  diminished;  the  tongue 
more  thickly  coated,  but  white  and  moist.  Pres.  Blister  over  the 
caecum ;  half  a  Seidlitz  powder  every  hour,  and  an  enema  to  be  re- 
peated every  third  hour,  until  free  evacuations  shall  be  procured. 

Evening.  She  has  had  several  small  evacuations  of  a  greenish 
fluid,  with  no  soHd  faecal  matter.  Pres.  5  grs.  Dover's  powder  to  be 
given  every  three  hours.  Simple  dressing  to  the  blister,  over  which 
is  to  be  laid  a  warm  bran  poultice. 

lUh.  She  has  had  a  quiet  night,  free  from  pain.  Skin  moist. 
Pres.  The  following  enema,  to  be  administered  directly:  Castor  oil 
|ij.,  spirits  turpentine  |ij.,  warm  water  two  pints. 

2  p.  M.  In  the  course  of  the  forenoon,  she  had  several  evacuations 
of  dark  faecal  matter  in  which   there  were   several  hard  masses  con- 


36  The  Peninsular  and  Independent. 

taining  portions   of  several  partially  digested   gooseberries.     Pres.  Half 
a  Seidlitz  powder  every  two  hours. 

Evening.  She  has  had  several  evacuations  of  greenish  faecal  matter 
during  the  afternoon.     Pres.  6  grs.  Dover's  powder. 

l^tli.     Convalescent. 

On  the  8th  of  June,  1844,  a  similar  attack  occurred  after  eating 
unripe,  or  but  partially  ripened,  cherries.  Under  a  similar  course  of 
treatment  she  got  relief  on  the  fourth  day  after  the  attack,  but  the 
soreness  and  tumefaction  subsided  much  more  slowly  than  in  the  first 
instance. 

On  the  14th  of  September  following  she  was  seized  in  the  same 
way  —  but  the  case  proved  much  more  obstinate  than  in  either  of  the 
former  attacks,  yielding  to  the  treatment  on  the  fifteenth  day  after  its 
commencement. 

On  the  3d  of  December,  of  the  same  year,  she  had  a  recurrence 
without  any  known  cause,  except  a  bad  cold,  under  which  she  had 
been  suffering  several  days.  This  lasted  until  the  21st,  or  eighteen 
days  from  its  commencement.  Prom  this  time  until  the  following  spring, 
she  was  constantly  troubled  with  constipation  of  the  bowels,  attended 
with  flatulence,  together  with  more  or  less  tenderness  and  pain  in 
the  caecum  and  ascending  colon.  Her  general  health  suffered  mate- 
rially until  the  23d  of  April,  1845,  when  she  had  another  attack,  at- 
tended with  more  acute  inflammatory  symptoms  than  either  of  the 
former,  involving  the  peritoneum  to  considerable  extent.  This  occur- 
red in  three  or  four  hours  after  eating  boiled  cabbage.  By  the  use 
of  an  emetic  most  of  this  was  thrown  off  from  the  stomach,  in  an 
undigested  state,  together  with  a  quantity  of  green  bile.  The  inflamma- 
tion subsided,  under  active  treatment,  in  the  course  of  six  days,  and 
the  bowels  slowly  regained  their  natural  powers  so  far  as  to  be 
comfortable  under  a  carefully  regulated  diet,  with  the  occasional  use 
of  tonic  laxatives. 

We  occasionally  meet  with  instances  in  which  the  vermiform  ap- 
pendix seems  to  be  the  principal  seat  of  the  primary  disease.  This 
is  generally  occasioned  by  the  accidental  intrusion  of  some  small, 
hard  substance  into  its  cavity,  which  its  free  communication  with  the 
cascum  readily  allows ;  while  there  is  no  way  of  escape  but  by  a 
retrograde  movement.  Whether  this  organ  has  the  power  of  expel- 
ling offending  matter  in  this  way  or  not,  it  is  well  known  that  they 
sometimes  become  impacted  in  this  narrow  tube,  giving  rise  to  irri- 
tation and  inflammation,  which  result  in  perforative  ulceration  of  its 
coats  with  most  disastrous  consequences. 

Mr.  Copland  mentions  having  seen  four  cases  of  this  description, 
where  the  appendix  was  primarily  and  chiefly  affected,  owing  to  hard 
substances  having  escaped  into  it.  All  of  these  cases  terminated  in 
general  peritonitis  and  gangrene  of  the  appendix. 


Selected  Articles^  Abstracts^  <bc,  37 

It  appears  from  his  description  of  this  affection,  that  in  the  cases 
which  he  has  seen,  the  symptoms  from  the  beginning  were  more 
acute  than  in  inflammation  of  the  caecum  itself. 

Two  well  marked  instances  of  this  affection  have  fallen  under  my 
observation,  one  of  which  was  occasioned  by  the  presence  of  two 
biliary  concretions  lodged  in  the  appendix.  The  symptoms  in  these 
cases  were  less  urgent  than  in  those  related  by  him;  although  the 
sequel  was  the  same. 

Case  VI.  This  occurred  in  a  young  man  about  17  years  of  age, 
while  attending  school  at  the  Canandaigua  Academy.  I  first  saw  him 
on  Tuesday,  June  6,  1837.  He  complained  of  sickness  at  the  stomach, 
and  pain  in  the  umbilical  region.  He  attributed  his  illness  to  the 
eating  of  oranges  on  the  previous  evening.  I  gave  him  calomel  and 
rhubarb,  of  each  10  grains  in  powder,  and  directed  hot  fomentations 
*o  the  abdomen. 

I  called  again  in  four  hours.  The  sickness  had  subsided  and  pain 
somewhat  abated;  gave  him  castor  oil  and  aromatic  syrup  rhubarb 
each  1  oz. ;  fomentations  to  be  continued,  and  a  copious  enema  to  be 
administered  in  three  hours. 

1th.  The  bowels  have  been  freely  moved ;  still  complains  of  pain 
about  the  umbilicus.  On  carefully  examining  the  abdomen,  I  discov- 
ered tenderness  on  pressure  deep  in  the  lower  part  of  the  right  iliac 
fossa ;  no  febrile  movement  has  manifested  itself 

I  applied  a  blister  to  the  right  ilio  -  inguinal  region,  and  directed 
calomel  and  Dover's  powders,  each  3  grains,  to  be  repeated  every  four 
hours. 

Evening.  Several  times  during  the  day  he  has  rejected  from  the 
stomach  small  quantities  of  greenish  watery  fluid,  which  has  left  a 
slight  stain  upon  the  tongue.  The  blister  has  filled  well ;  Dover's 
powder  and  calomel  to  be  continued  through  the  night. 

^tJi.  Kested  well  during  the  night;  pulse  76,  soft.  Skin  moist; 
thin  white  coat  upon  the  tongue ;  not  dry ;  no  pain,  but  little  soreness ; 
blister  looks  well.  I  gave  him  ten  grains  of  calomel,  to  be  followed 
in  three  hours  with  a  draught  of  infusion  of  senna  and  Epsom  salt. 

Evening.  His  medicine  has  operated  several  times  during  the  day. 
The  evacuations  contain  a  large  quantity  of  faecal  matter  but  with- 
out faecal  odor.  He  expresses  himself  as  feeling  relieved.  Directed 
Dover's  powder  for  the  night. 

Wi.  Had  a  quiet  night.  No  pain,  but  some  soreness  in  the 
right  iliac  region.  Heavy  white  coat  on  the  tongue ;  pulse  78,  soft, 
and  yielding  readily  to  slight  pressure.  Has  had  a  small  evacuation 
from  the  bowels.  No  faecal  odor;  blister  reapplied,  A  Seidlitz  pow- 
der to  be  given  every  three  hours. 

Evening.  Bowels  have  been  moved  several  times,  evacuations  not 
examined.     Entirely  free  from  pain.     I  spent  more  than  an  hour  with 


38  The  Peninsular  and  Independent. 

him,  in  company  with  some  friends,  who  had  called  on  him.  He  left 
his  bed  and  walked  to  his  chair  without  assistance.  Conversed  freely, 
and  desired  permission  to  ride  to  his  friends'  the  next  day  —  a  distance 
of  10  miles  —  which  I  advised  him  to  defer  for  a  few  days.  Every 
thing  seemed  quite  favorable,  excepting  a  very  heavy,  white,  clammy 
coat  spread  entirely  over  his  tongue.  A  Dover's  powder  was  the 
only  medicine  prescribed  for  the  night. 

\^th.  I  was  called  to  him  very  early  this  morning,  and  found  him 
in  articulo  mortis. 

On  post-mortem  examination,  assisted  by  Dr.  Bristol,  there  was 
found  in  the  pelvis  about  half  a  pint  of  purulejit  matter.  The  verm- 
iform appendix  presented  an  opening  about  one  inch  from  its  attach- 
ment to  the  caecum,  in  which  lay  a  biliary  concretion  about  the  size- 
of  a  common  white  bean,  and  nearly  of  the  same  shape.  On  raising 
the  appendix,  it  separated  from  the  caecum,  and  was  found  in  a  gan- 
grenous state  through  its  whole  extent.  About  half  an  inch  above 
the  ulcerated  opening  already  mentioned,  there  was  an  enlargement  of 
the  appendix  in  which  was  found  another  concretion  of  about  the 
same  size  and  appearance.  On  carefully  cutting  open  the  concretions, 
they  were  found  to  be  composed  of  concentric  layers  of  dense  biliary 
concretion  around  a  common  centre  of  the  same  material.  Marks  of 
recent  inflammation  were  traceable  to  a  great  extent,  over  the  perito- 
neum as  well  as  the  small  intestines. 

The  most  remarkable  feature  in  this  case,  is  the  amount  of  or- 
ganic lesion  of  so  obstructive  a  character,  with  no  more  urgent 
symptoms. 

In  the  other  instance  of  this  description  of  disease  to  which  allu- 
sion has  been  made,  the  symptoms  were  more  nearly  allied  to  those 
of  strangulated  hernia.  The  appendix  was  found  imbedded  in  a  mass 
of  omentum,  greatly  hypertrophied,  and  in  a  state  of  ulceration.  The 
cavity  of  the  appendix  was  nearly  obliterated  by  a  thickened  con- 
dition of  its  mucous  membrane  which  had  assumed  a  kind  of  firm, 
pulpy  consistence.  Portions  of  the  mucous  membrane  of  the  c«cum 
also  presented  a  similar  appearance. 

Affections  of  the  appendix  are  not  generally  distinguishable  from 
those  of  the  caecum  itself,  during  the  life  -  time  of  the  patient.  "We  may 
sometimes  suspect  them  when  the  seat  of  the  affection  is  deep  in  the 
pelvis,  as  this  organ  is  frequently  found  depending  in  this  situation. 
This  was  noticed  as  detailed  in  Case  VI.  The  soreness  was  deep- 
seated  in  the  pelvis,  which  led  to  the  suspicion  that  the  appendix 
was  the  principal  seat  of  the  affection.  Indeed  the  opinion  was  ex- 
pressed before  the  post-mortem  examination.  But  the  situation  of 
appendix  varies  so  much  in  different  individuals,  that  even  this  sign 
can  lead  to  nothing  more  than  a  mere  suspicion;  nevertheless,  this 
fact  is   often  very  important  in  its  practical  results. 


Selected  Articles^  Abstracts^  dtc.  3d 

In  the  dissections  which  I  have  made,  I  have  not  discovered  much 
uniformity  either  in  the  size  or  shape  of  the  appendix,  or  of  its  place 
of  origin,  nor  of  the  direction  which  it  takes  on  leaving  the  caecum. 
Among  my  dried  preparations,  I  have  one  colon  of  common  size,  in 
which  the  appendix  measures  six  and  a  half  inches  in  length,  and  nearly 
half  an  inch  in  diameter ;  passing  off  in  nearly  a  straight  line  from  the 
most  depending  point  of  the  caput  cseci,  the  extremity  of  the  appendix 
resting  on  the  floor  of  the  pelvis.  I  have  another  colon  of  equal  size, 
in  which  the  appendix  is  less  than  two  inches  in  length,  and  no  thicker 
than  a  crow's  quill.  This  has  its  origin  just  at  the  margin  of  the  ilio- 
caecal  valve,  is  coiled  upon  itself,  and  firmly  bound  to  the  caecum  by  a 
fold  of  peritoneum.  In  another  specimen,  the  appendix  measures  four 
inches  in  length;  has  its  origin  within  half  an  inch  of  the  termination 
of  the  ileon,  and  makes  a  turn  round  this  intestine,  firmly  embracing 
it.  I  have  preserved  nine  preparations  of  the  caecum  and  appendix,  all 
of  which  vary  materially  in  their  form  and  construction,  so  that  no 
general  description  will  answer  to  any  two  of  them. 

Dr.  BuKNE  observes,  that  "The  conformation  and  situation  vary 
much  in  different  individuals  —  a  fact  not  noticed  by  anatomists,  but 
which  I  have  found  to  influence  the  phenomena  and  nature  of  its  dis- 
eases very  considerably.  The  conformation  of  the  appendix  is  generally 
described  as  flexuous;  and  its  situation  as  depending  into  the  pelvis; 
but  by  some  the  situation  is  not  noticed,  further  than  that  the  appen- 
dix arises  from  the  caecum,  and  is  bound  down  to  it  on  the  right  by 
a  fold  of  peritoneum,  the  meso  -  appendix ;  whereas  the  appendix  is 
more  frequently  situated  on  the  outer  edge  of  the  psoas  magnus,  on 
the  fascia  iliaca,  snugly  curled  up  beneath  the  caecum,  and  concealed 
by  it  —  a  fact  which  I  have  verified  by  many  dissections,  and  one  of 
great  importance  to  the  pathologist,  as  will  be  seen.  In  the  event  of  a 
perforative  ulceration  of  the  appendix,  and  a  consequent  peritonitis  or 
faecal  absess,  the  parts  involved  will  differ  entirely,  according  to  the 
situation  of  appendix.  If  it  should  happen  to  depend  into  the  pelvis, 
then  the  pelvic  viscera  will  be  implicated;  if  it  should  happen  to  be 
situated  on  the  iliac  fascia,  and  underneath  the  caecum,  then  the  belly 
of  the  iliacus  internus  and  the  neighboring  adipose  cellular  tissue  will 
be  involved,  and  the  course  of  the  abscess  be  determined  accordingly : 
so  important  is  the  relative  anatomy  of  even  inconsiderable  organs  to 
to  the  physician." 

The  foregoing  cases  are  selected  from  eighteen  well  marked  instances 
of  this  class  of  affections  which  have  occurred  under  my  own  observa- 
tion during  the  last  fourteen  years.  I  met  with  several  other  examples 
of  this  disease  during  the  earlier  years  of  my  practice,  of  which  no 
notes  were  made  at  the  time.  I  have  also  occasionally  seen  cases  in 
consultation  with  neighboring  physicians,  so  that  abundant  evidence  is 
afforded  of  their  frequent  occurrence,  at  least  in  this  section  of  the 
country. 


40  The  Peninsular  and  Independent. 

They  are  spoken  of  by  some  medical  writers  as  being  obscure  in  their 
origin,  and  often  difficult  of  detection.  Professor  Albers,  of  the  Uni- 
versity of  Bonn,  makes  the  following  remark,  "That  the  diagnosis  of 
the  diseases  of  the  caecum  is  attended  with  no  inconsiderable  difficulty 
appears  from  the  well  known  circumstance,  that  very  often  they  have 
never  been  suspected  to  exist  during  the  life  of  the  patient,  and  have 
been  discovered  only  on  dissection." 

Dr.  BuRNE  remarks,  that  "A  practitioner  who  witnesses  one  of  these 
cases  for  the  first  time,  is  satisfied  it  is  not  a  common  inflammation  of 
the  bowels,  although  he  does  not  know  its  exact  nature  —  he  says  the 
case  is  a  curious  one  —  he  can  not  make  it  out." 

DupuYTREN,  in  speaking  of  the  importance  of  a  correct  diagnosis  in 
these  affections,  says,  "I  have  seen  this  inflammation  give  rise  to  the 
belief  of  the  existence  of  internal  strangulation,  hepatitis,  and  even 
peritonitis."  That  these  affections  are  sometimes  mistaken  for  common 
inflammation  of  the  bowels,  or  "Bilious  Colic,"  I  am  fully  aware,  hav- 
ing been  consulted  in  four  well  marked  cases,  the  true  nature  of  which 
had  been  entirely  misapprehended.  One  of  these  terminated  in  the  usual 
way  by  resolution  —  the  other  three  were  allowed  to  pass  on  to  suppu- 
ration, one  of  which  terminated  fatally,  the  abscess  bursting  into  the 
peritoneum.  The  other  two  cases  opened  externally,  a  little  above  the 
crural  arch,  one  of  which  formed  ill-  conditioned  sinuses  which  remained 
open  more  than  a  year  —  and  finally  recovered. 

The  causes  of  failure  in  diagnosis  are  probably  owing  in  part  to 
the  mildness  of  the  earlier  symptoms,  which  attract  but  little  atten- 
tion from  the  patient  or  physician ;  but  principally  to  the  fact,  that 
the  pain  attending  them  is  generally  described  by  the  patient  as  a 
colic,  and  is  frequently  referred  to  the  umbilical  region,  or  to  the  abdo- 
men generally.  Indeed  it  is  very  rare  that  the  patient  directs  attention 
to  the  seat  of  the  disease. 

It  is  only  by  a  careful  examination  that  the  nature  and  seat  of 
the  difficulty  are  detected.  By  gentle  pressure  or  percussion  over  the 
surface  of  the  abdomen,  as  you  approach  the  right  iliac  region,  the 
patient  shrinks  from  you,  or  perhaps  instantly  seizes  your  hand,  and 
betrays  surprise  at  the  discovery  of  such  exquisite  tenderness. 

Hence  the  importance  of  carefully  examining  every  part  of  the 
abdomen,  in  these,  as  well  as  in  all  other  affections  of  the  abdominal 
viscera. 

If  we  take  into  consideration  the  situation  of  the  caecum,  fixed 
as  it  is  in  the  parietes  of  the  abdomen,  admitting  of  no  considera- 
ble variation  in  its  relative  position  with  regard  to  the  other  viscera, 
it  must  be  evident,  that  with  such  an  examination  the  disease  under 
consideration  would  seldom  escape  early  detection. 

The  progress  of  the  phenomena  as  developed  in  these  affections, 
is   thus   described  by    M.    Dupuytren:      "After  some   error  in   diet,   a 


Selected  Articles^  Abstracts^  <kc.  41 

constipation  or  diarrhoea,  of  longer  or  shorter  duration,  more  or  less 
habitual  colic ;  sometimes  without  any  of  these  causes,  the  patient 
suffers  from  violent  colic  and  pain  in  the  bowels,  with  a  tendency 
to  concentration  in  the  right  iliac  fossa ;  it  may  also  extend  towards 
the  large  intestine,  or  over  the  whole  abdomen.  This  colic  is  gen- 
erally accompanied  by  constipation,  and  sometimes  vomiting;  such  are 
the  symptoms  by  which  we  may  predict  th6  occurrence  of  the  tumor. 
They  are  of  very  various  duration;  sometimes  lasting  for  a  month  or 
more,  sometimes  for  a  few   days  only." 

Dr.  Hays,  Editor  of  the  American  Journal  of  the  Medical  Sciences 
(see  Medical  Essays,  vol.  1,  page  81,  published  by  Lea  &  Blanch- 
ARD,  1841),  says:  "The  disease  usually  announces  itself  by  certain  ^r«- 
cursory  symptoms,  as  colic,  with  alternate  constipation  and  diarrhoea, 
occurring  at  longer  or  shorter  intervals,  and  continuing  for  a  greater 
or  less  period.  After  a  while  the  attacks  of  colic  become  more  severe, 
and  appear  to  centre  in  the  right  iliac  fossa;  they  may  also  radiate  in 
the  direction  of  the  great  intestine,  or  spread  over  the  whole  cavity 
of  the  abdomen.  These  pains  are  usually  attended  with  obstinate 
constipation,  and  sometimes  with  such  violent  vomitings  as  to  simulate 
an  internal  strangulation.  In  some  cases  the  disease  has  its  origin, 
is  attended  with  less  violent  symptoms,  and  commences  with  pain  in 
the  right  iliac  fossa.  If  this  region  be  examined,  it  will  be  found 
more  tender  to  the  touch,  more  resisting,  and  sometimes  to  project 
more  than  in  the  natural  state.  It  is  frequently  possible,  by  press- 
ing upon  the  abdominal  parietes,  to  distinguish  a  circumscribed  tumor 
of  variable  size,  of  considerable  firmness,  more  sensible  to  the  touch 
than  any  other  part  of  the  abdomen,  and  appearing  to  rest  upon  the 
csecum ;  the  remainder  of  the  abdomen  is  soft  and  indolent.  The 
patient  continues  at  the  same  time  to  complain  of  colic  and  consti- 
pation." 

Dr.  BuRNE,  in  the  papers  to  which  we  have  already  alluded,  gives 
the  following  graphic  description  of  these  affections:  "In  all  the  ex- 
amples of  inflammation  of  the  caecum,  which  I  have  witnessed,  the 
development  of  the  symptoms  has  been  in  the  following  order:  The 
first  sign  is  a  sense  of  uneasiness,  which  soon  amounts  to  an  aching 
pain,  deep  -  seated  in  the  right  ilio  -  inguinal  region,  arising  unexpect- 
edly while  the  person  was  in  health,  and  not  preceded  by  rigor  or 
exposure.  This  pain  increases  progressively  for  twelve  or  twenty -four 
hours,  retains  its  character,  is  fixed  and  constant,  never  even  remit- 
ting. Then  supervene  gradually  tenderness,  fullness,  and  tension  of 
the  whole  ilio  -  inguinal  region;  the  bowels  are  constipated  and  do  not 
reply  to  medicine,  and  the  patient  grows  sick  and  vomits.  Some 
febrile  movement  now  begins  to  manifest  itself;  the  tongue  becomes 
white  and  furred;  the  urine  scanty;  the  appetite  is  gone;  the  pulse 
is  frequent,   tight,  and  sharp,    with   increased   volume,    but  the  stroke 


^2  The  Peninsular  and  Independent, 

though  sharp,  is  not  strong,  nor  is  its  impression  on  the  finger  de- 
cided—it is  a  pulse  of  irritation  and  inflammation  combined;  the 
patient  lies  on  the  back  quite  still,  slightly  inclined  to  the  side  affected, 
and  the  case  presents   a  serious  aspect." 

The  above  is  certainly  a  faithful  delineation  of  most  of  the  symp- 
toms which  are  usually  manifested  in  these  cases,  but  these  phenomena 
are  most  invariably  preceded  by  a  series  of  '^precursory  symptomSy'^ 
as  noticed  by  Dr.  Hays. 

By  referring  to  the  cases  detailed  by  Dr.  Burne,  it  appears  that 
no  one  of  them  came  under  his  observation  earlier  than  the  fifth  day 
after  the  attack ;  a  circumstance  which  fully  explains  the  cause  of  his 
having  failed  to  notice  the  symptoms^  which  usually  precede  what 
may  be  considered  as  signs,  peculiar  to  these  affections. 

Instead,  therefore,  of  waiting  for  the  development  of  local  signs, 
these  symptoms  should  at  once  awaken  our  suspicions,  and  if  we  are 
led  by  them  to  a  careful  examination  of  the  abdomen,  we  may,  even 
before  the  attention  of  the  patient  has  been  directed  to  the  part,  dis- 
cover a  circumscribed  fullness,  well  defined,  and  quite  tender  to  the 
touch,  situated  over  the  caecum.  It  is  during  the  prevalence  of  these 
earlier  symptoms,  that  a  well  directed  treatment  will  often  prove  most 
successful. 

The  course  of  practice  which  I  have  found  most  "successful  in  these 
cases,  previous  to  the  development  of  inflammatory  action,  is  a  free  use 
of  calomel  and  opium,  together  with  warm  fomentations  to  the  abdo- 
men. "When  the  system  is  fully  under  the  influence  of  opium  —  pain 
and  spasmodic  action  having  subsided  —  an  enema  of  castor  oil  and 
spirits  of  turpentine,  in  a  suflScient  quantity  of  warm  water  to  freely 
distend  the  colon,  will  generally  succeed  in  removing  the  offending  mat- 
ters. By  thus  removing  the  cause  of  the  diflSculty,  we  may  often  avoid 
the  more  serious  character  of  these  complaints.  If,  however,  this 
course  proves  unsuccessful,  and  inflammatory  action  supervene,  it  must 
promptly  but  cautiously  be  met;  and  here  I  can  not  do  better  than  to 
commend  as  worthy  of  special  attention,  the  following  judicious  obser- 
vations of  Dr.  James  Johnson.  "As  the  inflammation  is  the  result 
of  a  mechanical  source  of  irritation,  or,  perhaps,  obstruction,  it  is 
obvious  that  depletion  must  not  be  carried  to  so  gTeat  an  extent  as  in 
idopathic  enteritis.  Another  consideration  which  should  moderate  the 
employment  of  depletory  measures,  especially  of  local  or  general  blood- 
letting, is  the  reflection  that  the  patient  may  have  to  go  through  an 
iliac  abscess,  and  that  his  powers  should  be  husbanded  for  its  support. 
The  depletion,  then,  should  be  cautious ;  enemata,  and  such  purga- 
tives as  the  stomach  will  bear  well,  should  be  administered;  light 
poultices  and  fomentations  are  to  be  applied;  and  about  the  fifth  or 
sixth  day  the  bowels  may  begin  to  act,  and  the  symptoms  to  sub- 
side     Should  they   not   subside,    the  physician   or   surgeon   must  anx-. 


Selected  Articles^  Abstracts^  d;c.  45 

iously  watch  for  the  first  appearance  of  an  emphysematous  tumor, 
and  make  an  early  incision  into  it;  foetid  gas  escapes,  and  the  cel- 
lular tissue  is  more  or  less  sloughy,  or  actually  sloughing.  The 
patient  must  now,  of  course,  be  supported,  and  even  stimulated,  to 
the  necessity  pitch." 

There  seems  to  be  some  difference  of  opinion  among  practitioners, 
as  to  the  propriety  of  opening  these  abscesses  after  suppuration  has 
taken  place.  M.  Dupuytren  and  Dance  recommend  leaving  them  to 
the  efforts  of  nature,  allowing  the  matter  either  to  make  its  own 
way  to  the  surface,  or  to  escape  through  some  of  the  natural  passages ; 
while  on  the  other  hand,  Drs.  Hargkave  and  Kennedy,  of  Dublin; 
Drs.  Johnson  and  Copland,  of  London ;  and  Dr.  Hays,  of  Philadelphia, 
advise  a  free  opening  for  the  exit  of  purulent  matter,  as  soon  as  a 
tendency  to  the  surface  is  evident.  There  can  be  no  doubt  that  the 
latter  course  will  be  sustained,  when  experience  shall  have  decided 
their  relative  advantages. 

We  occasionally,  in  these  cases,  meet  with  an  exceedingly  irrita- 
ble condition  of  the  rectum.  Under  these  circumstances,  an  enema, 
by  a  common  syringe,  will  not  be  retained  in  sufficient  quantity  to 
be  of  much  advantage.  We  may  then  resort  to  the  use  of  an  elastic 
tube,  passed  high  up  into  the  colon,  as  recommended  by  Dr.  O'Beirn. 

I  have  during  the  last  two  years  made  use  of  the  tube  described 
in  connection  with  Case  IV.,  which  I  have  found  in  some  respects 
preferable  to  the  common  elastic  tube.  Its  advantages  consist  in  its 
being  of  sufficient  firmness  to  retain  whatever  shape  or  course  we 
may  choose  to  give  it,  previous  to  its  introduction,  while  the  bulb  at 
its  extremity  is  not  liable  to  be  obstructed  in  its  passage  by  the  loose 
folds  of  the  mucous  membrane;  we  consequently  avoid  all  danger  of 
breaking  the  tube,  or  of  injuring  the  coats  of  the  intestine. 

In  detailing  the  foregoing  cases,  I  have  appended  occasional  remarks ; 
not,  however,  for  the  purpose  of  offering  to  the  Profession  anything 
new,  but  rather  with  the  intention  of  directing  the  attention  of  the 
readers  of  your  Journal  to  a  class  of  affections  which  are  scarcely 
noticed  in  the  systematic  works  which  constitute  the  libraries  of  most 
country  practitioners ;  and  also  of  inviting  their  attention  to  the  articles 
from  which  I  have  drawn  so  largely  in  preparing  this  paper. 

[New  York  Journal  of  Medicine,  July,  1845. 


44  The  Peninsular  and  Independent. 


Hie  Improvements  made  to  the  Operation  for  Yesico  •  Taginal  Fistula  by  American 

Surgery. 

Translated  by  O.  D.  Palmer,  M.  D.,  from  the  Gazette  Hebdomadaire. 

•  FIRST  ARTICLE. 

In  the  course  of  the  month  of  November  past,  a  young  American  Sur- 
geon, Dr.  BozEMAN,  came  to  Paris,  and  had  a  run  through  our  hospitals. 
He  demonstrated  to  us,  both  theoretically  and  practically,  the  process 
which  he  put  in  use,  in  the  treatment  of  Yesico- Vaginal  Fistula  —  a 
process  which  has  acquired  for  him  in  the  United  States,  and  even 
in  Europe,  a  just  portion  of  celebrity.  Dr.  Roberts,  having  at  that 
time  under  his  care  in  the  "Hotel  Dieu,"  a  patient  twice  already 
operated  upon  without  success,  he  united  with  me  in  praying  Dr. 
BozEMAN  to  make  still  a  trial.  The  process  was  here  submitted  to 
a  severe  test,  for  the  case  was  but  little  favorable.  The  result  was 
altogether  satisfactory. 

Assisting  at  this  operation,  we  have  been  able  to  follow  atten- 
tively the  phases.  Two  things  particularly  struck  us :  the  great  facility 
of  Dr.  BozEMAN,  and  the  perfection  of  the  manual  operation  in  itself 
The  foreign  press,  besides,  informing  us  daily  of  the  numerous  successes 
obtained  by  this  method,  we  have  believed  it  utile  to  expose  to  light 
a  surgical  progress  that  does  the  greatest  honor  to  American  practice. 

But  in  taking  cognizance  of  the  subject,  and  in  consulting  the  pub- 
lished works,  we  saw  immediately  that  Dr.  Bozeman  had  been  preceded 
in  this  path  by  a  certain  number  of  his  countrymen,  and  we  encounter 
as  we  make  way,  questions  of  priority,  discussed,  unhappily,  with  acri- 
mony to  be  regretted.     From  thence  our  plan  changed. 

It  consorts  with  our  personal  inclinations,  and  with  the  usages  of 
this  journal,  not  to  recoil  from  the  exigencies  of  an  impartial  criti- 
cism, supported  by  history.  To  render  unto  each  whatsoever  pertains 
to  him,  seems  to  us  a  duty  altogether  imperious,  and,  besides,  much 
more  profitable  to  science  than  is  generally  supposed.  We  resolved, 
therefore,  to  throw  a  comprehensive  glance  over  the  whole  of  that  part 
of  American  surgery,  appertaining  to  Vesica -Vaginal  Fistula. 

It  is  in  1839,  that,  with  common  accord,  the  first  success,  if  not 
obtained,  was  at  least  published  to  the  United  States  by  Dr.  Hayward, 
of  Boston.  It  is,  then,  with  the  works  of  this  surgeon  that  we  will 
prosecute  our  inquiries  up  to  the  present  day,  in  the  meantime  attach- 
ing ourselves  less  rigorously  to  dates,  than  to  scrutiny  of  the  ideas 
that  have  been  exposed  to  light;  historical  criticism  having  for  its 
object,  above  all,  the  exposition  of  principles.  This  review  is  not, 
perhaps,  altogether  inoportune.  We  are,  in  fact,  suflBciently  inclined  to 
believe,  in  France,  that  no  where  can  we  be  equaled  in  surgery.  It 
would  be  dangerous,  as  well  as  unjust,  to  perpetuate  this  vain  -  glorious 
illusion,  for   we    strive   so   much   the   more   to  maintain   the  first  rank 


Selected  Articles^  Abstracts,  c^c.  45 

when  we  see  ourselves  threatened  with  being  surpassed ;  and  it  is  not  less 
important  to  our  dignity,  than  to  the  interests  of  humanity,  to  recog- 
nize the  progress  we  have  not  known  to  realize. 

I  come  to  the  subject. 

Dr.  Hayward,  of  Boston,  has  made  two  publications  on  VesicO' 
Vaginal  Fistula,  the  one  in  1839,  the  other  in  1851.  Each  contains 
important  ideas.     I  undertake,  then,  the  examination  of  the  cases. 

The  first  publication,  I  have  said,  dates  from  1839.  The  preced- 
ing year,  the  American  Journal  had  published  the  translation  of  two 
articles  from  Dieffenbach,  inserted  in  the  Berlin  MediciniscTie  Zeitung^ 
in  June  and  July,  1836.  Hayward  had  read  these  articles,  for  he 
cites  their  author,  and  quotes  from  the  Berlin  surgeon  favorable  modi' 
fications.  After  some  generalities,  he  gives  the  following  case,  of  which 
I  make  a  summary  analysis : 

Case.  A  woman,  aged  thirty -four  years,  experienced,  at  nineteen, 
a  laceration  of  the  Vesica -Vaginal  cloison,  in  consequence  of  a  labor 
of  three  days  duration.  Eleven  times  since  that  accident,  she  became 
pregnant,  but  never  was  delivered  at  term.  Cauterizations,  the  wearing 
a  sound,  were  employed  without  success.  The  opening  was  situated  a 
little  to  the  left  of  the  median  line,  at  an  inch  and  a  quarter  from  the 
meatus  urinarius.  It  scarcely  admitted  the  point  of  the  finger.  Its 
borders  were  in  a  manner  cartilaginous. 

The  operation  was  performed  the  10th  May,  1839,  in  presence  of 
many  distinguished  associates.  Put  in  position,  the  parts  were  well 
dilated,  a  large  bougie  was  introduced  into  the  bladder  as  far  as  the 
fistula.  By  the  assistance  of  this  instrument,  the  walls  of  the  bladder 
were  brought  downwards  and  forwards,  so  that  the  opening  became 
very  accessible  to  the  view;  an  assistant  maintained  the  bougie;  a 
rapid  incision  about  the  fistula,  one  line  from  its  borders ;  ablation  of 
the  whole  circumference.  The  walls  of  the  vagina  were  then  sepa- 
rated, from  the  paries  of  the  bladder,  by  dissecting  around  the  whole 
circle  of  the  opening,  to  the  extent  of  about  three  lines.  This  was 
done  in  order,  at  the  same  time,  to  augment  the  chances  of  union  ly 
opposing  a  larger  surface,  and  to  avoid  the  passage  of  the  ligatures 
through  the  coats  of  the  Madder.  A  needle,  introduced  a  third  of  an 
inch  from  the  scarified  i  border  through  the  walls  of  the  vagina,  and 
subjacent  cellular  membranes,  was  pushed  on  through  the  other  lip, 
so  as  to  pass  out  about  the  same  distance.  Before  withdrawing  it,  two 
other  needles  were  passed  in  the  same  manner,  and  as  they  were  suffix 
cient  to  close  the  orifice,  they  were  drawn  out  and  firmly  knotted, 
The  ends  were  cut,  leaving  them  about  three  inches  long.  There  was 
no  difficulty  in  applying  the  sutures  with  the  hand,  for  the  fistulous 
opening  had  been  depressed  in  such  a  manner  as  to  be  very  well  exposed 
to  view.  A  short  silver  catheter,  made  expressly,  was  placed  in  the 
bladder,  the  patient  was  returned  to  her  bed,  and  placed  on  her  right 
side,  so  as  to  prevent  the  contact  of  the  urine  to  the  wound. 


46  Ihe  Peninsular  and  Independent, 

"With  the  exception  of  the  same  smartings,  and  same  annoyance 
from  the  catheter,  which  otherwise  performed  very  well,  the  effects  of 
the  operation  were  very  mild.     Regimen:  arrowroot,  milk,  gum -water. 

The  catheter  was  taken  away  the  next  morning,  cleaned,  and  re- 
placed ;  light  pains,  always  referred  to  the  instrument ;  a  little  sleep,  no 
fever;  position  and  regimen,  ut  supra. 

During  five  days  all  went  well.     The  catheter  was  cleaned  every  day. 

Examination — with  a  speculum.  The  ligatures  held  firmly.  The 
wound  appeared  healed  in  all  its  extent ;  no  infiltration  into  the  vagina. 
The  vesico  retained  the  urine,  which  flowed  through  the  catheter  imme- 
diately this  was  introduced.  The  ligatures  were  taken  away,  which 
was  made  difficult  by  fear  of  rupturing  the  cicatrix,  if  the  bladder  was 
depressed  as  during  the  operation.  A  small  catheter  was  replaced,  and 
the  position  in  bed  preserved.  An  instrument  of  a  smaller  volume  re- 
lieved the  patient  much  during  two  days;  it  was  then  suppressed 
entirely.  The  patient  was  taught  to  sound  herself  every  three  hours, 
but  two  nights  later  she  slept  during  seven  hours,  notwithstanding 
which  she  experienced,  on  awaking,  no  inconvenience.  Twice,  also,  at 
this  epoch,  she  voided  her  urine  by  the  simple  contractions  of  the  blad- 
der, which  had  thus  recuperated  its  functions.  The  catheter,  however, 
was  still  introduced,  but  at  longer  intervals. 

Seventeen  days  after  the  operation,  a  new  examination.  The 
wound  was  entirely  healed  and  appeared,  solid.  The  patient  was  en- 
gaged to  sound  herself  two  or  three  times  per  day  for  several  weeks. 
The  next  day  she  returned  home  by  water,  a  distance  of  200  miles. 

"We  have  reported  the  first  case  of  Dr.  Hayward,  because  it 
contains  the  essential '  points  of  his  process.  We  have  seen  that  not 
only  his  operation  was  crowned  with  success,  but  also  that  the  con- 
sequences were  extremely  benign.  The  author  attributes  the  want  of 
grave  symptoms  to  the  absence  of  all  traction  experienced  on  the 
borders  of  fistula,  and  also  to  the  fact  that  the  bladder  was  not  in- 
cluded in  the  parts  through  which  the  needles  were  introduced. 

But  there  are,  in  this  process,  principles  involved  too  important 
to  permit  a  simple  mention  of  the  case  to  suffice,  particularly  if  we 
are  willing  to  consider  the  epoch  when  this  note  was  published  (1839). 
The  manual  operation  for  Vesico -Vaginal  Fistula,  had  been  then  much 
less  studied  than  in  our  days;  important  works  which  we  now  pos- 
sess, had  not  yet  been  published,  or  were  not  sufficiently  dissemin- 
ated. This  is  why  Dr.  Hayward  ought  to  be  considered  a  real  pioneer 
inovateur)  and  a    successful  pioneer. 

It  may  be  permitted  me  to  examine  separately  the  culminating 
points  of  his   operation. 

1st.  Coaptation  of  Large  Bleeding  or  Scarified  Surfaces.  This 
idea  pertains  to  Dieffenbach.  After  having  paired  perpendicularly 
the  borders   of  the  fistula,  to  the   extent  of  about  a  line,  he  proposed 


Selected  Articles^  Abstracts^  etc,  47 

and  executed  the  separation  of  the  mucous  membrane  of  the  vagina 
from  that  of  the  bladder,  to  the  extent  of  two  lines.  He  succeeded, 
by  this  means,  in  closing,  by  two  operations,  a  large  fistula,  in  a 
woman  of  twenty-eight  years.  He  says,  expressly,  that  this  dissecting 
asunder  has  for  its  object  the  obtaining  of  a  broad  surface  of  re-union. 
Dr.  Hayward  has  been  one  of  the  first  to  comprehend  all  the  import 
of  this   precept. 

2d.  Passage  of  the  Ligatures  exclusively  in  the  Vesica -Vaginal 
Cloison  without  wounding  the  Membranes  of  the  Bladder.  —  This  im- 
portant rule  has  been  closely  adhered  to  by  Dr.  Hayward,  who  at- 
tributes to  this  circumstance,  in  a  great  measure,  the  escape  from 
untoward  symptoms  in  the  operation.  It  is  an  incontestible  fact,  that 
in  the  ordinary  process  each  end  of  the  ligature  penetrating  the'  mem- 
branes of  the  bladder  create  thereby  a  passage  for  the  slow  infiltra- 
tion of  the  urine  into  the  lax  cellular  tissue,  as  is  well  known. 
Moreover,  there  has  been  frequently  observed  the  formation  of  small 
fistulas  produced  entirely  by  the  ligatures,  the  passage  of  which  they 
follow.  Finally,  these  same  ligatures  may  be  considered  as  a  cause 
of  inflammation,  and  inflammation  being  the  principal  cause  of  the 
want  of  success  of  sutures,  all  conspire  to  prove  the  value  of  a  pro- 
cess which  does  not  implicate  the  coats  of  the  bladder. 

3d.  Depressing  the  Vesico -Vaginal  Cloison,  in  order  to  render 
the  Fistula  accessille  to  mew  and  to  Instruments.  —  One  of  the  cir- 
cumstances which  has  most  retarded  the  progress  of  the  operation 
which  occupies  us,  is  the  difficulty  of  handling  instruments  at  the 
bottom  of  a  narrow  cavity,  and  of  being  able  to  scarify  and  stitch 
an  opening  scarcely  visible.  This  objection  disheartened  J.  L.  Petit. 
It  is  found  under  various  forms,  in  many  works  on  this  matter. 
Even  Lallemand,  himself  a  surgeon  so  skilled,  recoiled  before  this 
means,  and  it  is  from  these  obstacles  that  cauterization  owes  the  pri- 
vilege of  being  extolled  and  re -invented  constantly.  We  must  all 
admit  that  the  difficulty  is  great.  Dr.  Hayward  has  triumphed  over  it 
by   a  very   simple  process,   and  from  his  first   trial   in   1829. 

The  patient  being  placed  on  the  border  of  a  table,  in  an  oper- 
ating position,  and  the  parts  well  separated,  a  large  bougie  was  in- 
troduced into  the  urethra,  and  pushed  back  to  the  fistula.  By  this 
means  he  was  enabled  to  bring  the  bladder  down,  and  forwards,  in 
such  a  manner  as  to  expose  to  view,  with  facility,  the  opening. 
The  instrument  was  confided  to  an  assistant.  We  may  recall  to  mind 
that  the  fistula  in  the  present  case  was  situated  but  15  or  16  lines 
from  the  meatus  urinarius,  and  it  is  easy  to  comprehend  the  me- 
chanism of  the  manoeuvre.  The  instrument  introduced  by  the  urethra, 
acts  as  a  fixed  lever,  by  raising  towards  the  abdomen  the  external 
part;  the  vesical  portion,  together  with  the  superior  walls  of  the 
vagina,   are  depressed. 


48  The  Peninsular  and  Independent. 

In  resuming,  the  first  communication  of  Br.  Hayward  brought 
to   light,   in   1839,    two   important   precepts: 

1st.  The  opposition  of  large  bleeding  surfaces; 
2d.  The  position  of  the  ligature  outside  the  walls  of  the  bladder. 
In  1851,  Dr.  Hayward  published  a  second  memoir  on  the  Vesico- 
vaginal Fistula,  inserted  in  the  Boston  Medical  and  Surgical  Journal 
(April,  1851).  Before  passing  to  the  analysis  of  this  interesting  work,  we 
ought  to  consecrate  some  moments  to  two  other  celebrated  American  sur- 
geons ;  these  also  have  studied  the  same  subject.  I  wish  to  speak  of  Drs. 
Mettauer  and  Pancoast.  Unfortunately,  it  has  been  impossible  for  me  to 
consult  their  original  works ;  very  short  extracts  have  come  to  my  knowl- 
edge only,  and  I  have  a  long  time  since  learned  to  suspect  simple  citations, 
and  even  succinct  analyses. 

According  to  Dr.  Bozeman,  Dr.  Mettauer,  otherwise  known  by  numer- 
ous works  on  reparative  surgery,  had  attempted  the  operation  for  Vesico 
Vaginal  Fistula,  as  early  as  1830. 

Process  of  Mettauer. —  It  consists  in  scarifying  the  borders  of  the 
opening,  then  to  hold  them  in  contact  by  the  interrupted  suture,  made  with 
threads  of  lead.  These  threads  traverse  the  whole  Vesico -Vaginal  cloison, 
at  the  distance  of  an  inch  from  the  prepared  borders,  then,  when  they 
have  been  placed  in  sufficient  quantity,  the  ends  of  each  pair  are  twisted 
together  till  they  produce  an  exact  coaptation  of  the  lips.  They  are  then 
cut  on  the  outside  of  the  vulva.  On  the  third  day  this  leaden  wire  is 
tightened  by  a  new  torsion,  and  taken  away  finally  on  the  tenth  day. 

Dr.  Mettauer  has  often  employed  since,  the  same  mode,  without  much 
modification,  and  he  has  much  success. 

The  first  publication  of  this  surgeon  was  made  in  1847,  in  the  Vir- 
ginia Medical  and  Surgical  Journal,  which  it  has  been  impossible  for  me 
to  procure.  The  priority  of  printing,  then,  remains  to  Hayward,  who, 
besides,  proceeded  altogether  in  a  different  manner. 

I  have  been  equally  unable  to  consult  the  cases  of  Dr.  Pancoast, 
inserted  in  the  Medical  Examiner,  May,  1847.  By  good  fortune,  Dr.  Sims 
has  given  copious  extracts  from  them. 

Process  of  Br.  Pancoast,  of  Philadelphia. —  The  particular  character 
of  the  operation  is  in  re -uniting  solidly  the  borders  of  the  abnormal  open- 
ing, on  the  principle  of  the  tenant  and  mortise.  There  are  thus  placed  in 
contact  four  bleeding  surfaces,  which  augments  the  chances  of  union  by  the 
first  intention.  The  borders  should  have  a  considerable  thickness ;  when 
they  are  not  in  this  condition,  they  should  be  made  thicker  by  the  repeated 
application  of  the  nitrate  of  silver,  or,  better,  the  actual  cautery  {fer  rouge). 
The  parts  being  as  well  dilated  as  possible,  with  the  speculum  of  Char- 
RiERE,  the  mobile  valve  of  which  has  been  removed  in  the  same  time  that 
an  assistant  raises  the  vestibula  toward  the  pubis,  the  introduction  of  the 
operation  consists  in  splitting  the  posterior  lip  to  the  depth  of  half  an 
inch.     The  opposite  lip  is  then  paired  in  shape  of  a  wedge,  at  first  revers- 


Selected  Articles^  Abstracts^  c&c.  4,9 

ing  it  as  much  as  possible  with  an  obtuse  hook,  in  order  to  refresh  the 
mucous  membrane  of  the  bladder,  with  the  curved  scissors  and  scalpel ;  then 
in  abrading  in  turn  the  membranes  of  the  vagina  in  the  whole  lip  to  the 
extent  of  three -fourths  of  an  inch.  This  is  a  very  difficult  part,  but  a  very 
important  part,  of  the  operation.  The  hemmorrhage  arrested,  it  remains 
to  insert  the  bleeding  cuneiform  tenant,  into  which  the  anterior  lip  has 
been  converted,  into  the  groove  or  mortise  formed  by  the  posterior  lip,  and 
to  hold  the  parts  in  contact.  This  is  arrived  at  by  means  of  a  particular 
suture,  useful  in  many  plastic  operations,  and  described  by  the  author,  in 
the  American  Journal  tor  October,  1842. 

When  the  suture  is  knotted,  the  tenant  is  included  in  the  mortise ;  the 
ligatures  are  left  two  weeks  or  more,  till  they  become  lax :  elastic  catheter 
left  in  bladder  to  prevent  it  from  becoming  distended.  To  moderate  the 
inflammation  a  bladder  of  cold  water  is  applied  to  the  vulva  during  thirty- 
six  hours.  The  second  or  third  day  frequent  vaginal  injections  of  a  solu- 
tion of  sulphate  of  zinc,  to  augment  the  tone  of  the  parts.  On  the  fourth 
or  fifth,  a  pencil  dipped  in  a  solution  of  nit.  argt.  may  be  passed  over  the 
line  of  union.  We  may  count  on  an  immediate  union,  to  a  great  extent ; 
where  it  is  wanting,  the  secondary  re -union  is  provoked  by  the  solid 
nitrate  of  silver,  which  developes  a  crop  of  granulations  on  the  budding 
surface,  still  held  in  contact  by  the  plastic  suture. 

Dr.  Pancoast  has  cured,  by  his  process,  two  patients.  One  case  con- 
sisted in  a  complete  destruction  of  one  segment  of  the  urethra ;  the  other 
presented,  in  the  fundus  of  the  bladder,  an  elongated  opening,  more  than 
sufficient  to  admit  the  point  of  the  finger. 

We  again  recognize  the  principle  of  coaptation  of  excoriated  surfaces, 
carried  to  its  last  limits  by  Dr.  Pancoast  in  a  veritable  suture  by  scTiindy- 
lese.  We  very  well  comprehend  the  efficacy  of  the  operation,  which 
unfortunately,  would  seem  to  possess  extreme  difficulties  of  execution,  and 
which,  besides,  is  not  applicable  to  all  cases. 

I  have  knowledge  of  an  operation  very  analogous,  practiced  recently  by 
my  excellent  colleague,  Lenoir,  with  success.  It  was  a  fistula,  the  poste- 
rior borders  of  which  was  formed  by  the  os  uteri.  Two  operations  with 
ordinary  sutures  had  already  miscarried.  Dr.  Lenoir  formed  the  idea  of 
splitting  transversely  the  anterior  lip  of  the  neck,  in  such  a  manner  as  to 
form  a  profound  groove,  in  which  he  enclosed  the  anterior  lip  of  the  fistula. 
A  cure  was  effected.  It  is  a  case  which  would  merit  the  honor  of  a  detailed 
publication. 

I  still  remark,  in  the  consecutive  treament  instituted  by  Dr.  Pancoast, 
the  astringent  injections,  the  cauterization  with  nitrate  of  silver  to  the 
growing  cicatrix,  and  finally,  the  protracted  sojourn  of  the  sutures. 

This  process,  I  have  no  doubt,  might  be  useful  still,  in  certain  cases. 

Ar.  VERNEUIL. 


Vol.  it.  -  D. 


50  The  Peninsular  and  Independent. 


Dr.  Churchill  on  Consumption.  * 


As  the  medical  world  is  now  all  agog  in  discussing  the  value  of  the 
Rypophosphites  as  a  remedy  in  Phthisis,  it  may  be  interesting  to 
know  what  are  the  views  of  Dr.  Churchill  in  relation  to  the  me- 
dicine as  a  therapeutic  agent.  Most  persons  have  frequently  heard 
of  Dr.  Churchill,  though  but  few  have  heard  from  him.  The  fol- 
lowing letter,  which  we  get  from  the  Trihune^  was  addressed  to  Mr. 
J.   Winchester,  of  this  city: 

"Paris,   Dec.    17,   1858. 

My  Dear  Sir:  —  *  *  *  *  i  very  much  regret  my  utter  inability 
to  send  you  a  copy  of  my  work  on  Phthisis.  The  whole  edition 
was  sold  off  in  less  than  six  months,  and  it  has  now  been  out  of 
print  since  February  last.  *  *  *  I  am  now  engaged  upon  a  second 
edition,  which  has  been  delayed  with  the  hope  of  my  being  able  to 
settle  the  question  of  the  existence  or  non-existence,  in  the  human 
economy,  of  phosphorus  in  an  oxydizable  condition.  The  chemical 
proof  of  its  existence  in  such  a  state  I  now  confidently  hope  I  shall 
shortly  be  able  to   lay  before  the  profession  and  the  chemical  world. 

Your  reply  to  Mr.  Guilford's  claim  of  priority  is  perfectly  to 
the  point.  The  same  pretension  has  been  raised  here  by  two  differ- 
ent parties,  and  also  by  one  or  two  in  England;  but,  in  reality,  the 
use  of  phosphoric  acid,  in  Phthisis,  dates  as  far  back  as  1789,  when 
it  was  employed  in  Germany  by  J.  B.  Lentin.  Since  then,  the  phos- 
phates, especially  the  phosphate  of  lime,  have  been  used  by  many 
practitioners,  and  among  others  by  Dr.  Stone  of  New  Orleans.  That 
all  the  cases  in  which  they  are  stated  to  have  proved  beneficial  are 
to  be  rejected,  or  attributed  to  error  of  diagnosis,  I  am  not  at  all 
prepared  to  assert;  but  think  they  are  to  be  accounted  for  in  one 
of  the   two  following  ways: 

Any  mode  of  treatment  which  is  combined  with  rest,  and  im- 
proved diet  and  living,  may  prove  beneficial  by  stopping  or  dimin- 
ishing the  amount  of  waste  of  the  oxydizable  phosphorus.  The  phos- 
phates may,  therefore,  have  occasionally  appeared  to  be  of  use,  just 
as  may  have   change   of  climate,    homoeopathy,    or  anything  else. 

Phosphoric  acid,  as  shown  by  Weigel  and  King,  and  later  by 
DellA  Judda,  frequently  contains  phosphorous  acid,  an  oxydizable  com- 
pound, and  as  such  could  have,  in  accordance  with  my  hypothesis, 
a  curative  effect,    owing  to   its  very   impurity. 

My  views,  with  regard  to  Phthisis,  may  be  summed  up  in  very 
few  words,   and  are  as   follows: 

Phthisis    is    a    diathesis   or   general    disease,    depending   upon   the 


*¥vom  American  Druggists'  Circular,  March,  1850. 


Selected  Articles^  Abstracts^  etc,  61 

want  or  undue  waste  of  thes  oxydizable  phosphorus  normally  existing 
in  the  animal  economy.  Hence  it  follows  that  the  remedy  consists 
in  supplying  the  deficient  element  by  the  administration  of  any  pre- 
paration of  phosphorus  which  is  at  once  assimilable  and  oxydizable. 
Now,  phosphorus  itself  possesses  the  latter  quality,  and  has  occasionally 
been  used  with  success;  but  is  has  not  the  first,  and  is  so  dangerous 
a  substance,  that  it  has  fallen  into  complete  disuse.  Phosphoric  acid 
is  assimilable,   but  not  oxydizable. 

The  Rypop'hosp)hites  combine  both  qualities  in  the  highest  degree, 
being  perfectly  soluble,  and  nearly  as  oxydizable  as  phosphorus  itself; 
for  which  latter  reason  I  originally  preferred  them  to  the  pliosphites, 
which  are  less  so. 

As  to  the  cause  of  Consumption,  my  hypothesis  leads  also  to 
one  or  two  other  consequences  of  the  highest  importance  in  practice, 
viz.  ^  Although  the  hypophosphites  are  the  specific  remedy  of  the 
diathesis,  they  can  not  cure,  by  their  own  direct  action^  the  local 
diseases  which  the  diathesis  may  have  produced  in  the  lungs  or  else- 
where, previous  to  the  employment  of  the  remedy.  To  expect  the 
contrary  would  be  just  as  reasonable  as  to  think  that  the  water 
thrown  upon  a  burning  building  can  do  the  work  of  the  mason  or 
the  carpenter. 

The  repair  of  such  local  disorder  is  brought  about  by  the  special 
energy  of  the  parts  affected,  and  will  take  place  in  all  cases  in  which 
the  destruction  of  the  parts  involved  has  not  gone  beyond  a  certain 
extent.  The  degree  of  the  disease  I  hold  to  be  of  less  moment  than 
the  extent^  and  incline  to  go  so  far  as  to  look  upon  Phthisis  in  the 
third  stage  as  of  a  more  favorable  prognosis  than  in  the  second,  all 
other  circumstances  teing  equal.  The  prognosis  of  each  individual  case 
will,  therefore,  depend  upon  two  points  — the  extent  of  the  existing 
lesion,   and  upon   the  presence  or  absence  of  complieation. 

Another  consequence,  which  is,  if  possible,  of  still  greater  im- 
portance than  the   cure  of  the   disease,   is  the  following: 

If  consumption  depends  upon  the  waste  of  the  oxydizable  phos- 
phorus, it  follows  that  the  hypophosphites  not  only  have  a  remedial, 
but  a  preservative  power.  In  fact,  they  are  a  complete  proi^hylactic, 
Such,  I  am  confident,  will  prove  to  be  the  case;  and  the  time  will 
come,  I  hope,  when  Phthisis  and  Tuberculosis,  instead  of  occupying 
the  first  place  in  the  causes  of  mortality,  will,  like  small-pox  at  the 
present  day,    form   a  comparatively   insignificant  item. 

My  reason  for  this  confidence  is  not  derived  from  my  assurance  of 
the  correctness  of  my  general  theory,  but  from  the  invarialle  efficacy 
with  which  I  have  found  them  act  in  all  incipient  cases,  even  of  the 
acute  kind  commonly  called  galloping  consumption. 

I  am  anxious  that  all  these  assertions  should  be  verified  by  the 
medical  profession  throughout  the  world.     With   them,  and  them  only. 


52  The  Peninsular  and  Independent, 

does  it  rest  to  establish  or  to  deny  their  validity.  Unfortunately,  the 
past  history  of  our  art  shows  that  every  discovery  in  therapeutics  has 
been  met  with  a  storm  of  prejudice  and  opposition  such  as  finds  no 
parallel  except  in  the  records  of  religious  dissension.  I  might  have 
much  to  relate  on  that  head  in  my  own  case,  but  prefer  leaving  such 
matters  in  the  obscurity  to  which  posterity  is  sure  to  consign  them. 

If,  as  you  say,  the  people  of  the  United  States  take  an  interest  in 
my  discovery,  the  only  way  in  which  I  should  wish  them  to  show  it 
would  be  by  inducing  the  Medical  Profession  among  you  to  give  my 
treatment  a  fair  and  complete  trial,  which,  I  conceive,  can  only  be  done 
upon  the  following  conditions: 

1.  That  no  case  shall  be  considered  to  have  any  bearing  at  all 
upon  the  question  at  issue,  unless  it  be  expressly  shown  that  all  the 
conditions  which  I  have  laid  down  as  necessary  have  been  complied 
with. 

2.  That  in  each  case  not  only  the  degree,  but  also  the  extent,  of 
the  tubercular  deposit  pre  -  existing  to  the  treatment  shall  be  recorded* 
together  with  the  symptoms  upon  which  this  diagnosis  is  founded. 

3.  That  the  treatment  used  shall  be  the  Hypophosphites  as  I  have 
employed  them.  I  do  not  consider  myself  in  anywise  responsible  for 
the  ill  success  of  every  crude  formula  which  may  be  imagined  by  other 
practitioners. 

As  soon  as  my  new  edition  is  through  the  press,  I  shall  have 
much  pleasure  in  forwarding  you  a  copy  of  it,  and,  meanwhile,  I 
remain  Your  very  obedient  servant, 

J.  F.  CHURCHILL, 
17  Boulevard  de  la  Madelaine. 
J.  Winchester,  Esq. 

ASH  TEA  AS  A  EEMEDY  FOR  THE  BITE  OF  A  RATTLESNAKE. 

A  correspondent  of  the  Nashville  Journal  of  Medicine  and  Surgery 
affirms  that  a  tea  prepared  from  the  bark  of  the  ash  is  a  reliable  rem- 
edy for  the  bite  of  a  rattlesnake.  He  does  not  give  the  variety  of  the 
ash  tree  used,  nor  very  definite  directions  as  to  its  preparation.  His 
treatment,  however,  is  the  administration  of  "about  one  pint  of  ash 
tea,  prepared  by  taking  a  handful  of  the  inner  bark  of  the  ash,  adding 
one  quart  of  water,  and  boiling  down  to  a  pint."  About  half  a  gill  is 
to  be  taken  every  twenty  minutes. 


PUERPERAL  CONVULSIONS  TREATED  WITH  THE  NETTLE. 

Dr.  Wm.  Hauser,  of  Jeflferson  County,  Ga.,  mentions  in  the  Ogle-^ 
thorpe  Medical  and  Surgical  Journal,  a  case  of  convulsions  a  short  time 
prior  to  labor,  in  which  he  employed  the  cow  nettle  (the  urtica  dioica),, 


Selected  Articles^  Abstracts^  dc.  63 

in  the  form  of  infusion.  For  this  purpose  he  employed  the  balls  of 
this  plant,  just  then  maturing,  and  it  seems  with  complete  success,  the 
relief  being  almost  immediate.  The  convulsions  were  very  severe,  the 
xjhild,  which  was  delivered  a  few  hours  after,  being  badly  crushed.  He 
had  previously  employed  anodynes,  antispasmodics,  bleeding,  &c.  It  is 
to  be  hoped  that  the  call  w^hich  he  makes  upon  the  profession  to  an- 
alyse the  plant  and  ascertain  its  therapeutic  value  will  not  remain  un- 
answered. 


COD  -  LIVER  OIL  CAKES. 

We  have  examined  a  specimen  of  gingerbread  made  by  Messrs. 
Newberry  —  each  cake  containing  a  spoonful  of  Cod -Liver  Oil.  The 
gingerbread  is  extremely  light  and  pleasant,  the  flavor  of  the  oil  being 
<;ompletely  covered.  This  seems  likely  to  prove  a  very  useful  mode  of 
administering  Cod -Liver  Oil  to  children,  and  to  others  who  are  nause- 
ated by  the  offensive  odor  and  flavor  of  the  oil  as  generally  taken. — 
Medical  Times. 


PRESERVATION  OF  SPECIMENS  OF  DISEASED  MEMBRANES. 

Dr.  Arnold,  of  Savannah,  has  pursued  the  following  plan  with  suc- 
cess during  three  years.  The  specimen  is  well  washed,  and  one  side 
is  sprinkled  with  arsenic,  but  not  too  thickly.  It  is  then  spread  on 
a  pane  of  glass,  and  its  free  surface  is  thickly  powdered  with  arsenic, 
which  is  revived  when  absorbed — the  specimen  being  kept  in  the 
shade.  When  dry  it  is  covered  with  a  coat  of  white  varnish,  and 
when   this  has   dried,   by  another  pane   of  glass. 

PORT  WINE  ENEMATA. 

Dr.  H.  L.  Williams  recommends  an  enemata  of  port  wine  as  a  sub- 
stitute for  transfusion  of  blood  in  cases  of  post-partum  hemorrhage, 
and  records  {British  Med,  Jour.^  Sept.  4,  1858)  a  case  in  which  he 
successfully  resorted  to  it.  The  patient  was  in  the  most  alarming 
state  of  prostration,  pulseless  at  the  wrist,  with  cold  extremities,  &c. 
Dr.  W.  commenced  by  administering  four  ounces  of  port  wine  with 
twenty  drops  of  tincture  of  opium.  The  patient  speedily  manifested 
«igns  of  improvement.  In  half  an  hour  he  repeated  the  enemata  with 
marked  advantage,   and  the  patient  was  soon   out  of  danger. 

NEURALGIA. 

Dr.  ALEXAJiTDER  WooD  Operated  at  the  Infirmary  before  the  mem- 
bers of  the  British  Association,  at  the  late  meeting  in  Edinburgh, 
«on  two   patients  for  neuralgia,  according  to  a  plan  proposed  by  him. 


54  The  PeninsulaT  and  Independent. 

This  consists  in  injecting  under  the  skin,  at  the  most  painful  part 
of  the  nerve,  a  few  drops  of  Battley's  solution.  The  patients  ex- 
pressed themselves  relieved,  and  Dr.  Wood  speaks  of  the  process  as 
the  most  certain  and  effective  means  of  curing  all  forms  of  neuralgia. 

TiEMANN  has  produced  one  of  the  most  beautiful  specimens  of  skill, 
in  point  of  delicate  workmanship.  It  is  a  small  syringe,  with  steel 
points,  1%  inches  long,  and  only  %  a  line,  or  the  24th  of  an  inch  in 
diameter.  These  points  are  of  cast  steel,  and  an  orifice  is  drilled 
through  the  whole  length,  the  ©nd  is  sharpened,  and  the  whole  is 
especially  adapted  to  carry  out  Dr.  Wood's  process  of  injecting  ano- 
dynes or  haemostatics. 


CARBON"ATE  OF  AMMONIA  IN  THE  BITES  OF  POISONOUS  REPTILES. 

Dr.  A.  S.  Payne,  of  Paris,  Fouquier  Co.,  Ya.,  from  long  experience 
in  the  treatment  of  poisoning  by  snake  bites,  spider-bites,  etc.,  has  come 
to  the  following  conclusions: 

"1st.  That  hartshorn  is  the  natural  remedy  or  antidote  for  the 
cure  of  all  bites  of  poisonous  reptiles  or  stings  of  insects  which  exert 
a  rapid  and  depressing  influence  upon  the  heart's  action. 

"2d.  That,  in  my  opinion,  second  to  the  hartshorn,  in  remedial 
virtues,  stands  an  etherealized  solution  of  iodine. 

"3d.  That  the  biniodide  of  mercury  has  proven  itself  next  most 
valuable. 

"In  the  fourth  place  of  value  I  place  various  plants  indigenous  ta 
the  United  States  of  America." 

[  Virginia  Med.  Jour,  and  Am.  Jour.  Phar 


lljarmarewtital  f^prtnunt* 


Propylamin. 

This  organic  alkaloid  having  recently  come  into  use  in  Philadel- 
phia, in  testing  its  asserted  powers,  as  a  specific  in  Kheumatism, 
Prof.  Procter  gives  a  formula  for  its  preparation.  Though  it  can 
be  prepared  artificially,  and  is  found  naturally  combined  with  an  acid 
in  several  plants,  yet  he  recommends,  as  a  most  convenient  source^ 
herring  pickle — the  process   as  follows: 

Propylamin  is  prepared  by  taking  any  convenient  quantity  of  herring 
pickle,  obtained  from  the  dealers  in  salt  fish ;  this  is  put  in  a  retort  or 
tight  still,  with  sufficient  potash  to  render  the  liquid  strongly  alkaline,  and 
the  liquid  heated.  A  well  refrigerated  receiver,  containing  some  distilled 
water,  being  attached,  heat  is  applied  as  long  as  the  distillate  has  the  odor 
of  herrings.  This  is  then  saturated  with  hydrochloric  acid,  evaporated 
carefully  to  dryness,  and  the  dry  crystalline  mass  exhausted  with  absolute 
alcohol,  which  dissolves  the  propylamin  salt  and  leaves  the  muriate  of 
ammonia.  From  the  former,  the  pure  propylamin  may  be  obtained  in 
solution  by  means  of  hydrate  of  lime,  using  strong  precautions  to  refri- 
gerate and  condense  the  vapors,  which  are  actively  disengaged  almost 
without  heating. 

The  author  further  states  that  Propylamin  is  a  colorless,  trans- 
parent liquid,  with  a  strong  pungent  odor  that  reminds  one  of  am- 
monia,  and   quotes  Dr.  Awenarius   of  St.   Petersburg,   as   follows: 

Propylamin,  as  obtained  from  the  pickle  of  herrings,  codliver  oil, 
ergot,  human  urine,  etc.,  appears,  according  to  the  author,  to  possess  the 
power  of  a  true  specific  for  the  various  affections  of  rheumatic  origin.  The 
diagnosis  of  these  diseases  being  often  very  obscure,  one  can  succeed  by 
the  use  of  propylamin  in  bringing  to  light  in  a  few  days  the  true  nature  of 
the  malady.  The  author  has  treated,  by  means  of  this  remedy,  250 
patients  in  the  hospital  of  Kaulinkin,  at  St.  Petersburg,  between  March, 
1854,  and  June,  1856;  and  besides,  it  has  been  employed  in  outside 
practice  in  a  considerable  number  of  acute  and  chronic  cases  of  rheuma- 
tism. In  acute  cases  the  pain  and  fever  always  disappear  the  next  day. 
The  remedy  was  prescribed  in  the  following  manner,  viz. : 

I^.    Propylamin       ....     gtt.  xxv. 
Distilled  water      .         .         .         f-  1  vj.     Mix. 
and  when  necessary,  add 

Oleo  saccharum  of  peppermint      3  ij. 
Dose.     A  tablespoonful  every  two  hours. 


56  The  Peninsular  and  Independent. 

It  is  necessary  to  carefully  ascertain  if  the  medicine  is  fresh  and 
pure. 

Although  this  remedy  has  not  found  its  way  into  commerce,  it  is  to  be 
presumed  it  will  soon  be  readily  obtainable. 


Liquor  Cinchonse  Hydriodatus,  and  Liquor  Cinchonse  Hydriodatus  cum  Ferro. 

The  editors  of  the  Semi  -  Monthly  Medical  News  speak  favorably  of 
two  new  pharmaceutical  preparations  under  the  above  titles,  from  their 
own  experience,  in  common  with  that  of  several  Physicians  of  their  city, 
(Louisville,  Ky.)  They  were  introduced  by  Mr.  J.  C.  Christopher,  in  an 
article  upon  "Secondary  Syphilis,"  stating  that  in  cases  of  this  disease 
which  resist  the  ordinary  means  of  treatment,  with  the  use  of  these  prepa- 
rations all  the  virtues  of  Iodine  are  obtained,  without  its  irritating  effects. 
He  affirms  that  it  has,  in  his  hands,  effected  cures  in  cases  of  constitutional 
syphilis  which  had  failed  to  be  relieved  by  other  forms  of  Iodine,  and  that 
in  other  hands  it  had  proved  valuable  in  the  treatment  of  scrofula,  anemia, 
and  furunculoid  tendencies,  especially  of  epidemic  form. 

In  a  late  number  of  the  "iV^wJS,"  we  find  two  formulae,  proposed  by 
T.  E.  Jenkins,  Chemist,  of  Louisville,  which  we  give  below. 

Liquor  GinchoncB  Hydriodatus. 

Cinchon.    cort.    (Calisaya)           ....  1.2288  grs. 

Iodine  (in  fine  powder)             ......  1536     " 

Water  (distilled) 128    oz. 

Sulphuretted  hydrogen            ....          .  q.  s. 

Convert  the  iodine  into  hydriodic  acid  by  passing  a  current  of  washed 
sulphuretted  hydrogen  gas  into  sixteen  ounces  of  water,  through  which 
the  iodine,  in  powder,  is  gradually  mixed;  after  the  whole  of  the  iodine 
has  been  converted  into  hydriodic  acid,  and  the  watery  solution  has  become 
white,  filter  the  solution  and  heat  the  filtered  liquor  until  the  excess  of 
sulphuretted  hydrogen  is  entirely  driven  off",  the  resulting  liquid,  which 
should  be  colorless  and  transparent,  is  a  solution  of  hydriodic  acid. 

With  one -half  this  solution  of  hydriodic  acid,  and  as  much  water  as 
may  be  necessary,  thorougly  moisten  the  cinchona  bark,  in  moderately  fine 
powder ;  allow  the  mixture  to  stand  for  twenty  -  four  hours ;  then  transfer 
the  mixture  to  a  percolator,  and,  by  the  process  of  displacement,  exhaust 
tlie  bark  with  a  mixture  of  the  remaining  half  of  the  solution  of  the 
hydriodic  acid  and  the  water.  The  last  portion  should  be  displaced  by 
pure  water.  If  the  resulting  fluid  measure  over  128  fluid  ounces,  it  should 
be  reduced  to  that  quantity  by  gentle  evaporation ;  if  less,  the  percolation 
may  be  continued  with  water  until  the  proper  measure  be  obtained. 

Each  teaspoonful  of  this  preparation  contains  the  active  principles  of 
12  grains  of  the  best  variety  of  Peruvian  bark  and  1%  grains  of  iodine  in 
the  form  of  hydriodic  acid,  all  in  perfect  solution,  and  entirely  compatible 
with  ferruginous  compounds. 


Liquor  Cinchonce  Hydriodatus  cum  Ferro. 

Liquor  cinchonas  hydriodatus  may  be  mixed  with  solutions  of  salts  of 
iron  without  producing  the  ordinary  effects  of  incompatibility  which  follow 
the  admixture  of  ferruginous  compounds  with  the  officinal  preparations 


Pharmaceutical  Department.  •        57 

of  bark.      The  following  formula  will  yield  a  handsome  and  stable  combi- 
nation of  liquor  cinchonse  hydriodatus  with  iron.     Take  of 

Cinchona  bark  (Calisaya)           ....  1.2288  grs. 

Iodine 1536     " 

Water 128    oz. 

Sulphuretted  hydrogen q.  s. 

Iron  wire ,     .         .  q.  s. 

Convert  512  grains  of  the  iodine  into  hydriodic  acid,  and  with  it 
exhaust,  by  percolation,  the  bark,  precisely  as  in  the  process  for  making 
"Liquor  Cinchonae  Hydriodatus."  While  the  exhaustion  of  the  bark  is 
going  on,  combine  the  remainder  of  the  iodine  (1024  grs.),  with  the  iron 
to  form  a  solution  of  iodide  of  iron,  as  described  under  the  head  of  iodide 
of  iron,  in  the  United  States  Pharmacopoeia ;  when  the  whole  of  the  liquid 
has  passed  from  the  bark,  filter  into  it  the  solution  of  iodide  of  iron,  and 
reduce  the  resulting  liquid  to  128  fluid  ounces. 

This  preparation  contains  in  each  teaspoonful  the  active  principles  of 
12  grs.  of  Peruvian  bark,  3^  gr.  of  iodine  in  the  form  of  hydriodic  acid, 
and  1  1-5  grs.  iodide  of  iron. 

In  both  the  Liquor  CAnchonce,  Hydriodatus  and  the  Liquor  CinchoncB 
Hydriodatus  cum  Ferro^  the  hydriodic  acid  is  combined,  and  forms  hydrio- 
dates  with  the  bases  in  the  bark. 


Cod  Liver  Oil  Jelly. 

Mr.  T.  E.  Jenkins  proposes  the  following : 

^.  Gelatin  (pure  and  white)     .         .         .         .         .         .        |    1 

Water        .         . 

Syrup  (aa)   .         .         .         .         .         .         .         .         .        |    8 

Cod  Liver  Oil     . 1 16 

Oil  Lemon 1  drop,  or  q.  s. 

Dissolve  the  gelatin  in  the  water  by  the  aid  of  a  gentle  heat,  add  the 
syrup,  and  then  incorporate  the  pil  by  thoroughly  beating  the  ingredients 
together,  lastly  add  the  oil  of  lemons  or  some  other  aromatic  essence  to 
suit  the  taste,  and  mix  well  together.  When  the  mixture  is  nearly  cold 
pour  it  into  wide  mouth  bottles.  Dose  from  one  to  two  tablespoonfuls 
three  times  a  day,  after  meals. 

[Semi  -  Monthly  Medical  Neios. 


Muriate  of  Ammonia. 

Quite  recently  this  substance  has  excited  some  interest  in  the  Medical 
world,  on  account  of  its  asserted  curative  power  over  several  forms  of 
Neuralgia;  and  we  present  to  our  readers  some  abstracts  from  a  paper 
upon  the  therapeutical  uses  of  Muriate  of  Ammonia,  written  by  Dr.  M. 
J.  Rae,  for  the  London  Lancet  (Feb.  1859).     He  says: 

I  have  prescribed  it  pretty  extensively,  in  various  diseases,  for  the 
last  eight  years  in  private  and  for  the  last  four  years  in  dispensary 
practice,  and  with  satisfactory  results.  The  hydrochlorate  of  ammonia, 
besides  being  liquifacient  and  resolvent,  as  mentioned  by  Sundelin, 
WiBMER,  and  others,  appears  also  to  possess  considerable  neurotic  action, 
as  is  shown  by  its  curative  power  in  neuralgia  and  other  nervous  dis- 
orders.    Its   remedial  influence   is   often  so  rapidly  manifested   in    these 


58  The  Peninsular  and  Independent, 

aflfections  as  to  preclude  the  idea  of  the  eflfect  being  owing  to  any  al- 
terative or  resolvent  action;  it  seems  more  rational  to  refer  it  to  a  di- 
rect or  peculiar  influence  of  the  salt  on  the  nerves  or  their  centres. 

I  have  used  the  salt  with  marked  success  in  goitre,  and  am  not 
aware  of  its  ever  having  been  tried  before  in  the  treatment  of  that  de- 
formity. In  several  cases  where  the  local  application  of  the  muriate 
was  conjoined  with  its  internal  administration,  the  tumors — some  of 
which  were  very  large — rapidly  diminished  in  size,  and  were  soon  re- 
duced to  the  normal  condition.  It  cured  the  whole  of  the  cases  (ten 
in  number)  in  which  it  was  tried,  the  period  of  cure  extending  from  a 
fortnight  to  two  months.  The  subjects  of  rteatment  were  mostly  fac- 
tory girls,  of  ages  varying  from  fourteen  to  twenty.  To  test  the  pow- 
ers of  the  muriate  fairly,  it  was  given  alone  in  mucilage,  or  infusion  of 
quassia,  and  combined  with  soap  liniment  for  external  use. 

As  goitre,  from  some  unknown  cause,  prevailed  here  last  year  to  a 
considerable  extent,  opportunities  were  thus  afforded  of  contrasting  the 
curative  power  of  the  muriate  with  iodine  in  this  affection.  Cases 
were  selected  where  the  tumors  were  nearly  all  of  equal  size  and 
duration,  and  where  the  age,  temperament,  general  health,  and  sanitary 
condition  of  the  individuals  corresponded  as  nearly  as  possible ;  and  in 
the  cases  treated  with  the  muriate,  which  was  used  both  internally  and 
locally,  the  tumors  generally  yielded  as  readil}'-,  and  sometimes  more 
quickly,  than  in  those  subjected  to  the  trial  with  iodine  similarly  em- 
ployed, and  apparently  quite  as  permanently.  The  muriate  appears  to 
be  a  safe  and  efficient  substitute  for  iodine  in  the  cure  of  bronchocele, 
and  worthy  of  further  trial.  The  hydrochlorate  of  ammonia  is  also  a 
valuable  remedy  in  hooping-cough.  I  was  first  led  to  make  trial  of  it 
in  the  treatment  of  pertussis,  from  a  belief  that  if  the  disorder  was  de- 
pendent— as  it  is  considered  to  be  by  some  pathologists — on  an  enlarged 
or  morbid  condition  of  the  lymphatic  glands,  or  that  the  exciting  cause 
of  the  paroxysm  was  owing,  as  is  very  probable,  to  the  presence  of 
irritating  glairy  mucus  in  the  bronchial  passages,  the  muriate,  on  ac- 
count of  its  alterative  power  in  glandular  enlargements  and  diseased 
mucoMS  structures,  and  its  effect  in  promoting  the  healthy  secretion  of 
the  mucous  membrane  in  cases  of  bronchitis,  accompanied  with  the 
discharge  of  tenacious,  glairy  mucous,  ought  to  prove  an  excellent  rem- 
edy in  the  treatment  of  that  often  troublesome  affection.  The  result 
was  most  satisfactory.  It  was  tried  in  thirty -seven  cases,  ten  of  which 
were  private  patients,  and  the  rest  home  patients  at  the  dispensary, 
which  were,  for  most  part,  under  the  charge  of  Mr.  Langsfoed,  house- 
surgeon  to  the  institution,  to  whom  I  am  indebted  for  the  efficient 
carrying  out  of  the  treatment,  and  for  a  report  of  the  cases.  Of  the 
number,  two  died — two  were  doubtful  cases,  the  patients  having  been 
removed  from  town  before  the  cure  was  completed.  In  the  thirty -three 
remaining  cases,  the  majority  of  which  were  of  more  than  ordinary  se- 
verity, the  average  period  of  cure  w^as  about  twenty  days.  But,  in 
most  instances,  where  the  patient  was  at  all  favorably  placed,  and  came 
early  under  treatment,  the  disorder  yielded  in  from  nine  to  fifteen 
days. 

The  remedial  influence  of  the  muriate  in  the  disorder  is  immediate 
and  decided.  Under  its  use  the  expectoration  soon  loses  its  irritating 
glairy  character,  becoming  bland  and  less  tenacious,  and  the  par- 
oxysms are  rendered  milder,  less  frequent,  and  of  shorter  duration  ;^  in 
fact,  by  its  influence  the  little  patient  seems  to  be  carried  more  easily, 
quickly,  if  not  at  the  same  time  more  safely,  through  the  attack  than 
by  the  agency  of   any  other  remedy  with  which  I  am  acquainted.      In 


Pharmaceutical  Departmeyit.  59 

most  cases  the  muriate  was  given  in  mucilage,  or  with  liquorice  water, 
combined  with  an  aromatic,  and  in  doses  of  one  to  five  grains,  accord- 
ing to  the  ages  of  the  child,  and  repeated  every  four  or  six  hours. 

When  pneumonic  or  bronchial  complications  existed,  or  were  threaten- 
ed, antimonial  or  ippecacuanha,  with  morphia  or  hyoscyamus,  were  added 
to  the  ordinary  mixture.  The  only  inconvenience  observed  to  result  from 
the  use  of  the  muriate  was  the  occasional  supervention  of  a  slight  mucous 
diarrhoea,  which  was  easily  checked,  and  did  not  interfere  with  the 
treatment. 

I  can  confirm  the  favorable  opinion  of  other  observers  as  to  the  efficacy 
of  the  muriate  in  enlarged  lymphatic  glands,  and  in  indolent  bubo,  and 
can  confidently  recommend  it  in  scofulous  ulceration  of  the  lymphatic 
glands.  There  are  few  more  intractable  cases  to  be  met  with  in  dis- 
pensary practice  than  those  of  extensive  ulceration  of  the  cervical  lym- 
phatic glands,  which  frequently  occur  in  weak,  under -fed,  and  badly- 
lodged  children.  In  several  aggravated  cases  of  this  sort  which  have  come 
under  my  own  observation,  some  of  which  presented  a  chain  of  foul,  ragged 
ulceration  extending  from  ear  to  ear,  the  muriate  acted  with  great  rapidity; 
and  in  some  instances,  where  iodine,  syrup  of  iodide  of  iron,  and  other 
medicines,  had  no  effect,  the  ulcerations  quickly  healed  under  its 
employment. 

It  is  also  a  very  excellent  remedy  in  many  forms  of  cutaneous  affections, 
more  especially  in  the  scaly  variety.  I  have  seen  cases  of  psoriasis  in- 
veterata  which  had  resisted  the  long  continued  use  of  arsenic,  iodine,  and 
other  remedies,  quickly  yield  to  its  influence.  It  seemed  to  me  to  have 
the  most  decided  eflfects  in  those  cases  of  psoriasis  occurring  in  patients  of 
dissipated  habits,  or  when  complicated  with  enlarged  liver.  It  is  also  very 
useful  in  eczema  and  syphilitic  squamae.  Drs.  Watson,  Ebden,  and  others, 
recommend  the  muriate  in  tic  and  facial  neuralgia,  and  it  certainly  possesses 
very  considerable  curative  power  over  these  painful  affections,  and  parti- 
cularly over  that  form  of  neuralgia  mentioned  by  Dr.  Watson,  which  is 
confined  chiefly  to  the  lower  part  of  the  face,  and  in  a  very  troublesome 
variety  affecting  one  or  other  side  of  the  neck,  and  probably  connected 
with  a  morbid  condition  of  the  cervical  lymphatic  glands. 

The  muriate,  like  other  remedies  in  neuralgia,  does  not  succeed  in  every 
case ;  but  in  those  cases  in  which  it  proves  successful,  the  beneficial  effect 
generally  follows  soon  after  its  administration.  In  my  hands  the  best  re- 
sults were  obtained  with  it  in  neuralgia  when  it  was  given  in  the  ordinary 
dose,  and  repeated  every  half  hour  or  hour. 

Never  having  occasion  to  prescribe  the  salt  in  the  large  doses  recom- 
mended by  some  authorities,  I  have  not  observed  any  irritant  or  injurious 
effects  on  the  stomach,  intestines,  or  other  organs,  to  follow  its  employment. 
When  given  to  adults,  in  from  five  grain  to  scruple  doses,  in  mucilage  or 
bitter  infusion,  with  aromatics  and  anodynes,  it  may  be  continued  for  a 
considerable  time  without  producing  any  unpleasant  results.  The  or- 
dinary dose  to  adults  was  from  five  to  ten  grains  three  or  four  times  daily. 
It  was  seldom  necessary  to  increase  the  dose  beyond  the  latter  quantity. 


Iron  reduced  by  Carbon ; 

A  new  preparation,  introduced  by  a  German  Pharmacien  —  M.  A. 
Henry,  of  Giromans  (Upper  Rhine).  It  consists  of  an  intimate  mixture 
of  metallic  iron  and  carbon,  obtained  by  calcining  the  pyrolignite  of 
iron.  It  is  in  the  form  of  a  light,  porous,  impalpable,  non  -  pyrophoric 
carbon,  of  which  the  composition  is  uniform  when  the  operation  has 
been  properly  conducted. 


60  The  Peninsular  and  Independent. 

The  great  tenuity  and  slight  density  of  this  carboferric  powder 
renders  easy  its  suspension  in  liquids,  to  the  bottom  of  which  it" does  not 
precipitate  like  iron  reduced  by  hydrogen.  The  presence  of  a  notable 
quantity  of  charcoal  has  the  advantage  of  rendering  the  product  more 
spongy,  more  absorbent,  of  facilitating  thus  the  contact  of  the  ferrugineus 
particles  with  the  liquids  of  the  stomach,  and  of  preventing  by  a  special 
action,  analogous  to  that  of  the  charcoal  of  Belloc,  the  eructations  of  the 
stomach  produced  by  preparations  of  iron. 

The  clinical  trials  made  by  Dr.  Benoit,  cantonal-physician  at  Giro- 
mans,  goes  to  confirm  the  efficacy  of  this  new  product,  which  M.  Henry 
had  rationally  foreseen  from  its  chemical  composition.  The  following  are 
the  conclusions  to  which  this  operator  has  been  led. 

Iron  reduced  by  carbon,  in  the  dose  of  1%  to  2  grains,  three  times  a 
day,  has  all  the  efficacy  of  the  best  preparations  of  iron.  Perfectly 
suspended  it  has  never  caused  constipation  nor  dyspeptic  exacerbations 
which  so  often  follow  the  use  of  the  soluble  preparations  of  iron,  and  it 
possesses,  nevertheless,  an  activity  much  greater  than  the  insoluble  pre- 
parations, which  are  frequently  resorted  to  at  first.  The  mean  duration  of 
43  cases  of  chlorosis  was  two  days  and  the  mean  quantity  of  the  medicine 
administered  was  11  grammes  168  grains.  The  efficacy  of  this  product, 
its  easy  preparation,  and  moderate  price,  recommends  it  to  practitioners, 
especially  in  medicines  for  the  poor. 

\Am.  Journal  Phar.  from.  Gaz.  Med.  de  Strassbourg. 


ON  THE  EXTERNAL  USE  OP  HYDROCHLORIC  ACID. 

In  the  course  of  some  investigations  made  with  reference  to  the 
physiology  and  pathology  of  the  skin,  Prof.  Kletpinsky  found  that, 
among  all  the  agents  subjected  to  the  test,  none  was  as  efficient  in  ex- 
citing the  respiratory  function  of  the  skin,  accelerating  the  capillary 
circulation,  and  influencing  the  action  of  the  lymphatic  and  glandular 
system,  as  hydrochloric  acid.  Skin  moistened  with  hydrochloric  acid 
expired,  under  the  same  circumstances,  twenty -seven  to  thirty  per 
cent,  more  of  carbonic  acid,  and,  what  is  very  remarkable,  seven  to 
twelve  per  cent,  less  of  water,  than  an  equal  space  of  skin  not  subjected 
to  the  influence  of  the  acid.  This  fact  induced  the  author  to  apply  the 
acid  in  a  great  number  and  variety  of  cases,  in  order  to  test  its  thera- 
peutical efficacy.     He  obtained  the  following  results: 

1.  Hydrochloric  acid  restores  and  stimulates  the  circulation  if  peri- 
odically interrupted  or  stagnating;  it  thus  cures  frost-bite  and  chilblain, 
and  is  an  efficient  prophylactic  against  these  complaints. 

2.  The  acid  diminishes  the  troublesome  perspiration  of  the  hands 
and  feet,  and  cures  it  in  some  cases  completely,  if  the  application  is  con- 
tinued long  enough. 

3.  It  is  an  efficient  remedy  in  a  great  variety  of  cutaneous  diseases, 
particularly  in  follicular  acne ;  by  rendering  the  metamorphosis  of  tissues 
more  active,  it  destroys,  if  steadily  used,  many  maculae  and  exudative 
patches  of  the  skin. 

4.  It  does  not  injure  the  integrity  of  the  epidermis,  if  properly  ap- 
plied, but  diminishes  its  roughness  and  callosities ;  like  a  true  cosmetic, 
it   renders   the   skin   pliable   and   soft,  increasing   at  the   same  time  its 
density,  and  making  it  consequently,  more  resistant  to  obnoxious  influ- 
ences. 

The  hydrochloric  acid,  which  must  be  free  from  admixture  of  iron 
or  chlorine,  is   best  applied  in   as   concentrated  a   condition   as  can  be 


Pharmaceutical  Department.  61 

borne,  without  its  giving  rise  to  burning;  commonly,  a  more  conceur 
trated  acid  can  soon  be  made  use  of,  even  if  it  was  inapplicable  at  the 
beginning  of  the  treatment.  The  skin  is  moistened  with  the  acid, 
(which  was  used  by  the  author  in  many  cases  even  in  its  fuming  state,) 
and  is  washed  off  after  a  quarter  of  a  minute,  at  first  with  water  and 
then  with  soap.  It  is  easily  understood,  that  the  hands  bear  most  easily 
the  concentrated  acid,  the  feet  (especially  the  toes)  less,  the  forehead  the 
least ;  on  all  sensative  places  of  the  skin  the  acid  must  be  applied  more 
diluted  and  for  a  shorter  time.  It  is  an  excellent  plan  to  mix  the  hy= 
drochloric  acid  with  glycerin,  the  therapeutical  action  of  which  on  the 
skin  is  hardly  enough  appreciated,  and  which  in  this  case  renders  a 
longer  application  of  the  acid,  even  to  a  sensative  skin,  practicable. 

[Osterreichische  Zeitschrift  fiir  Praktische  Heilkunde,  No.  xii.,  from  North  Amer^ 
tcan  Medico  -  Chirurgical  Review. 


MERCURIAL  OINTMENT. 

M.  CoLDEFUER,  a  chcmist  of  Geneva,  describes  a  new  method  of  mak- 
ing mercurial  ointment,  discovered  by  him  accidentally  during  the  progress 
of  some  investigations  upon  ozone.  It  seems  that  tallow  becomes  ozonized 
in  the  presence  of  an  atmosphere  of  that  gas,  and  when  in  that  condition, 
by  simply  mechanical  action,  rapidly  absorbs  mercury.  The  process  for 
preparing  the  ointment  is  as  follows :  put  into  a  large  porcelain  capsule 
sixteen  ounces  of  lard,  perforated  with  holes,  so  as  to  increase  the  extent 
of  surface,  and  place  half  an  ounce  of  phosphorus  in  a  vessel  suspended 
on  a  thread  above  the  lard ;  cover  the  whole  with  a  glass  receiver,  and 
at  the  end  of  a  fortnight  ozonization  is  complete.  This  lard  so  prepared 
is  introduced  into  a  wide -mouthed  bottle,  and  melted  on  a  sand  bath  at 
a  temperature  of  194*^  F.  Four  ounces  of  mercury  are  now  gently  heated 
and  rapidly  poured  into  the  lard ;  the  vessel  is  then  briskly  agitated  for 
some  minutes,  and  the  operation  is  terminated  by  quickly  plunging  the 
vessel  in    cold  water. 

[New   Orleans  Medical  and  Surgical  Journa   May,  1858. 


ULMUS  FULVA. 

The  Ulmus  fuha  is  found  very  generally  throughout  the  middle  and 
south  of  Lower  Peninsula.  Hundreds  of  tons  of  the  valuable  inner 
bark  of  this  tree  are  collected  and  sent  east  every  year  from  our  State. 

The  following  is  a  statement  of  the  manner  of  curing,  etc.,  this 
bark,  as  related  by  a  person  who  makes  it  a  livelihood:  The  Indian 
name  in  Michigan  is  Sharscope ;  time  to  commence  collecting  is  15th 
of  May,  continuing  about  six  weeks.  Best  way  to  dry  the  bark  is  to 
nail  up  the  large  pieces  in  a  room  heated  by  a  stove,  or  else  in  the 
direct  sun -light.  Must  be  kept  from  rains  and  dew.  Requires  about 
three  days  to  thoroughly  dry,  in  favorable  circumstances.  The  larger 
trees  afford  the  most  brittle  and  thick  white  bark,  which,  if  white,  brings 
the  highest  price,  but  which  is  not  best  for  medicinal  use,  as  the  tough, 
stringy,  thin  bark  affords  the  best  and  most  mucilage.  About  half  the 
weight  of  the  green  bark  is  wasted  in  drying.  The  Indians  are  usually 
paid  one  cent  per  pound  for  collecting  the  green  bark,  and  the  price  of  the 
bark  when  brought  into  market  varies  from  five  to  ten  dollars  per  cwt. 
In  grinding  the  tough  bark,  it  yields  two -thirds  of  its  weight  of  super- 
fine flour,  and  the  balance  is  coarse  ligneous  powder,  suitable  for 
cataplasms. 

I  believe  that  considerable  slippery  elm  bark  is  exported.        F.  S. 


62  Ihe  Peninsular  and  Independent, 


CHICAGO  COERESPONBENCE. 


A  NEW  Medical  College  has  just  been  established  here.  The  Trustees 
of  Lind  University,  being  desirous  of  founding  a  Medical  Department 
in  their  institution,  proposed  such  advantageous  terms  as  enabled  several 
medical  gentlemen  of  this  city  to  organize  at  once  the  institution. 
These  gentlemen  had  long  been  desirous  of  improving  the  means  of 
Mea-i  Jt.  Education,  and  they  seized  upon  this  opportunity  to  establish 
a  school  upon  a  new  basis,  and,  as  they  believe,  upon  a  plan  far  supe- 
rior to  that  of  most  of  the  older  colleges.  The  faculty  consists  of 
Profs.  Davis,  F.  Andrews,  Johnson,  Byford,  Rutter  (Emeritus), 
IsHAM,  HoLLiSTER,  and  Mahla.     Two  chairs  are  yet  unfilled. 

Profs.  Davis,  Johnson  and  Byford,  lately  occupied  chairs  in  Rush 
Medical  College.  Prof  Andrews  formerly  held  a  chair  in  Michigan 
University.  Prof.  Rutter  (Emeritus),  is  the  gentleman  mentioned  so 
favorably  in  Meigs'  writings. 

As  intimated  above,  the  plan  of  the  College  is  different  from  that 
of  most  others  now  existing  in  our  country.  In  the  first  place,  the 
students  are  to  be  divided  into  Junior  and  Senior  classes.  The  Junior 
class  will  listen  to  lectures  upon  the  elementary  branches  only;  such 
as  Anatomy,  Physiology,  etc.  They  will  have  only  four  lectures  each 
day,  and  be  subjected  to  daily  examinations  on  the  previous  day's 
topics;  in  these  respects  adopting  the  excellent  practice  of  the  Univer- 
sity of  Michigan.  At  the  close  of  the  session,  the  Juniors  will  be  ex- 
amined upon  their  Junior  studies,  and,  if  found  worthy,  passed  to  Senior 
grade. 

At  the  same  time  that  the  Juniors  are  listening  to  lectures  upon  the 
elementary  department,  the  Seniors  will  be  attending  lectures  upon  the 
practical  branches;  such  as  Practice,  Surgery,  Obstetrics,  etc.,  the  num- 
ber of  Professors  being  so  increased  above  the  usual  number  as  to  en- 
able them  to  carry  on  both  classes  simultaneously. 

The  following  scheme  represents  the  curriculum  of  study : 
Junior  Lectures.  Senior  Lectures. 

Descriptive  Anatomy.  Theory  and  Practice,   and  Clinical 

Physiology.  Medicine. 

Pathology  and  Public  Hygiene.  Surgery  and  Surgery  Clinic. 

Materia  Medica  and  Therapeutics.        Obstetrics. 

Inorganic  Chemistry.  Surgical  Anatomy  and  operation  of 

Practical  Anatomy.  Surgery   (shown    on    dead  sub- 

jects). 

Medical  Jurisprudence  is  not  definitely  provided  for  yet,  but  will 
probably  be  assigned  to  some  legal   gentleman. 

The  Chairs  will  be  filled  as  follows: 
Practice^  by  Prof  Davis.  Physiology^  by  Prof  Johnson. 


Pharmaceutical  Department.  63 

Surgery^  by  Prof.  Andrews.  Pathology  (not  filled). 

Surgical  Anatomy^  by  Prof.  Isham.      Descriptive  Anatomy,  by  Prof  Hol- 

OdstetricSj  by  Profs.  Rutter  (Emer-         lister. 

itus),  and  Byford.  Materia  Medica  (not  filled). 

Chemistry,  by  Prof  Mahla.  Practical  Anatomy  (not  filled). 

The  vacant  Chairs  will  be  provided  for  shortly. 

It  is  proposed  to  make  the  course  some  four  weeks  longer  than  that 
of  the  old  college,  bringing  up  the  standard  in  that  respect  to  a  level 
with  the  best  Philadelphia  schools.  It  is  believed  that  the  division  into 
Junior  and  Senior  courses  will  give  opportunity  for  greater  thoroughness, 
and  enable  the  Faculty  to  stop  lazy  and  stupid  men  for  the  most  part  at 
the  beginning  of  the  Senior  course,  thus  avoiding  the  inconvenience  and 
mortification  suffered  by  the  poor  fellows  who  otherwise  would  only 
learn  their  fate  by  a  rejection  at  the  very  end  of  a  three  years' 
course.  It  enables  each  man  also  to  concentrate  his  attention  upon 
fewer  studies  at  a  time. 

Rush  Medical  College  proposes  to  fill  up  its  vacated  Chairs,  and  go 
on  as  usual.  Prof  Brainard  has  purchased  the  Medical  Journal  from 
Prof  Davis,  with  the  view  of  retaining  it  as  the  organ  of  the  old 
school. 

The  health  of  the  city  is  much  as  usual,  but  the  type  of  the  dis- 
eases is  not  as  sthenic  as  it  was  six  months  ago. 

Several  of  our  physicians  are  starting  for  Pike's  Peak. 

There  is  a  movement  to  put  the  City  Hospital  in  operation.  The 
Homoeopaths  don't  show  themselves  this  time  in  the  matter. 

A  new  medical  society  has  been  formed,  called  the  Academy  of 
Medicine,  mostly  of  members  from  the  old  organization.  X. 


-^~^•- 


AMERICAX  MEDICAL  ASSOCIATION. 


The  twelfth  annual  meeting  of  this  Association  will  be 
held  in  Louisville,  Kentucky,  on  Monday,  May  3d,  1859. 
The  secretaries  of  all  societies  and  other  bodies  entitled  to 
representation  in  the  Association,  are  requested  to  forward 
to  the  Secretary,  S.  M.  Bemiss,  at  Louisville,  correct  lists 
of  their  delegations  so  soon  as  they  may  be  appointed. 
The  Convention  of  Teachers^  invoked  by  a  resolution  of 
the  National  Association,  for  the  purpose  of  a  general  con- 
ference upon  the  best  means  of  elevating  the  standard  of 


64  The  Peninsular  and  Independent. 

Medical  Education  in  this  country,  will  meet  in  the   same 
city  on  Monday,  the  2d  of  April. 

Medical  journals  throughout  the  United  States  are  re- 
quested to  insert  the  above. 

S.  M.  BEMISS,  M.  D. 
Secretary  American  Medical  Association. 


£^^  It  may  be  proper  to  announce  that  one  of  our 
number,  Prof.  Palmer,  is  about  to  embark  for  Europe  to 
spend  some  eight  months,  on  a  tour  principally  for  profes- 
sional observation,  and  that  we  expect  from  him  regular 
contributions  during  his  absence.  He  hopes  to  visit  many 
of  the  places  most  interesting  to  Medical  men,  both  on  the 
Continent  and  in  G-reat  Britain,  and,  as  he  may  find  time, 
will  furnish  our  readers  with  some  of  the  results  of  his  ob- 
servations of  men  and  things. 

Our  promises  of  contributions  from  various  sources  are 
encouraging,  and  on  the  whole  our  literary  resources  have 
never  appeared  so  abundant  as  at  present. 

Arrangements  have  been  made  for  supplying  brief  ab- 
stracts from  the  whole  range  of  our  Periodical  Literature, 
and  efforts  will  not  be  wantino;  to  render  the  Jouimal  more 
interesting  in  the  future  than  during  the  past. 

Eds. 


THE 


PENINSULAR  and  INDEPENDENT 


MEDICAL  JOURNAL. 


Vol.  II.  DETROIT,  MAY,  1859.  N^o.  2. 


Original  C0mmiittirati0n5. 


ART.  YII.— Address  to  the  Graduating  Class  of  UniYersity  of  Michigan.* 

By  Richard  Inglis,  M.  D. 

In  Ancient  Greece,  the  students  of  Medicine  in  the  temple 
of  the  Asclepiades  advanced  by  gradations  similar  to  other 
associations^  whether  of  Religion,  Art,  Philosophy,  or  Poli- 
tics. They  were  required  to  pass  the  mysteries  of  the 
orders,  and  receive  the  degrees  indicative  of  the  different 
stages  of  progress — the  preparatory,  the  theoretical  or  study 
of  abstract  principles,  the  practical,  and,  lastly,  of  ability 
to  practice  and  teach.  Apart  from  these  mysteries  and 
religious  ceremonies,  the  course  of  instruction  in  those  an- 
cient schools  seems  to  have  differed  but  little  from  the 
most  approved  systems  of  the  present  day.  The  ceremony 
of  the  first  degree,  called  Purification,  was  performed  upon 
those  students  who  had  fitted  themselves  to  enter  upon  the 


*  Published  by  request  of  the  Graduating  Class. 
Vol  II.-E. 


66  The,  Peninsular  ayid  Independent. 

study  of  Medicine.  They  were  required  to  possess  a  natu- 
ral disposition  and  a  favorable  position  for  study,  early 
tuition,  and  love  of  labor.  The  next  degree  was  Illumi- 
nation ;  and  the  duties  which  preceded  this  ceremony  corres- 
pond with  the  practice  in  our  own  colleges  of  listening  to 
the  prelections  of  Professors,  in  connection  with  the  study 
of  authors.  The  next  grade  was  Inspection,  and  corres- 
ponds with  our  system  of  requiring  the  students  to  become 
familiar  with  the  treatment  of  diseases  under  the  in- 
struction of  preceptors,  and  in  a  clinical  course.  The 
next  ceremony  was  Coronation,  which  took  place  at  the 
completion  of  the  term  of  study,  and  was  an  evidence  of 
the  recipient's  fitness  for  assuming  the  duties  of  his  pro- 
fession, and  corresponds  with  the  present  ceremony  of 
Graduation.  Indeed,  the  practice  of  placing  a  wreath,  cap,  or 
crown,  upon  the  heads  of  those  who  were  admitted  into  full 
fellowship  at  those  ancient  schools,  was  continued  down  to 
the  period  of  the  middle  ages.  In  some  of  the  Universities 
of  Europe,  the  occasion  of  conferring  degrees  is  still  called 
croivning  or  capping  day,  from  the  practice  of  jjlacing  a 
cap  ujDon  the  head  of  the  graduate.  This  may  also  ex- 
plain the  fact,  that  while  the  statues  of  the  ancients  usu- 
ally represent  the  head  uncovered,  the  head  of  Hippoc- 
rates is   seen  covered  with   a   crown. 

Gentlemen  Graduates,  on  this,  the  day  of  your  Cor- 
ronation,  I  congratulate  you  upon  the  honorable  distinc- 
tions conferred  upon  you.  May  the  laurels  with  which 
you  have  to-day  been  crowned  never  fade,  but  prove  to 
be  the  adorning  of  real  merit,  of  genuine  acquirements, 
and  earnest  devotion  of  mind  and  heart  to  a  noble,  use- 
ful, and  heaven-honored  aim!  May  the  wreaths  which  now 
encircle  your  heads  be  ever  fresh ;  acquiring  new  beauty, 
as  you  wear  them  well,  and  new  splendor,  as  you  prove 
by  your  lives  that  they  were  not  misplaced  ;  may  their 
beauty  be   but  changed   to   brilliancy  as   you  pursue  the 


Address  to  Medical  Graduates  of  the  University.  67 

journey  of  life,  and  the  adorning  become  more  dazzling  as 
your  learning  and  usefulness  steadily  increase,  and  your 
aims   daily   become   more  exalted. 

You  bave  to-day  emerged  from  the  outer  temple  of 
^scuLAPius,  and  gladly  I  meet  you  on  the  threshold  of 
the  inner  court,  to  bid  you  welcome  as  priests  of  that 
temple  over  whose  portals  is  inscribed,  "Fok  the  Heal- 
ing OF  THE  Sick."  Welcome  to  share  the  toil  and  labor, 
the  self-denial  and  hardships  of  our  vocation  !  Welcome 
to  days  and  nights  of  anxious  regard  for  the  welfare  of 
your  race,  and  of  labor  and  study  for  the  advancement  of 
your  Profession !  But  welcome,  also,  to  the  honor  and 
privileges,  the  pleasures  and  recompenses,  of  a  useful,  re- 
spected, and  honorable  calling. 

Gentlemen,  the  position  you  have  taken  to-day  is  one 
of  high  honor,  is  fraught  with  most  important  results,  and 
demands  of  you  the  most  careful  guardianship,  as  it  has 
reference  to  responsibilities  and  engagements  affecting  the 
welfare  of  your  fellow -men.  Your  title  is  no  empty 
bauble ;  these  are  not  tinsel  crowns  that  have  been  placed 
on  your  heads.  You  have  earned  the  honors  conferred  on 
you  by  years  of  earnest  study  and  hard  head-work.  And 
now,  I  know,  that  with  glad  hearts  and  good  hopes — with 
the  fire  and  energy  of  youth  in  your  veins — with  the  honor 
of  your  Profession  on  your  shoulders,  and  devotion  to  the 
welfare  of  your  race  in  your  hearts — with  the  hopes  of  pa- 
rents and  friends,  the  earnest  well-wishes  of  your  Profess- 
ors, and  the  prayers  of  Christians  in  your  behalf,  to  en- 
courage you, — you  stand  ready  for  the  work  and  the  battle 
of  actual  life.  Kemember  that  the  Michigan  University 
has,  this  day,  trusted  you  as  standard-bearers  of  her  honor, 
and  she  expects  every  man  so  honored  to  do  his  duty. 
Emulate  the  zeal,  cultivate  the  virtues,  and  endeavor  to 
^void  the  errors,  of  the  great  and  good  men  who  have 
'adorned  our  Profession^  both  in  ancient  and  modern  times, 


ft8  The  Peninsular  and  Independent. 

— men  who  never  forgot  the  great  aim  of  their  lives,  de- 
votion to  the  cause  of  suffering  humanity,  and  who,  with 
a  rare  unselfishness,  heaped  up  stores  of  experience  and 
observation,  not  to  make  a  miser's  hoard  for  self- gratifi- 
cation, but  to  furnish  their  followers  with  ever-enlarging 
supplies  of  useful   knowledge. 

The  origin  of  Medical  Practice,  or  the  use  of  remedial 
agents,  may  be  sufficiently  accounted  for  by  the  prompt- 
ings of  human  sagacity,  seeking  relief  from  present  suffer- 
ing. It  is  reasonable  to  suppose  that,  in  some  form  or 
other,  the  practice  of  Medicine,  or  the  application  of 
knowledge  to  the  relief  of  abnormal  conditions  of  the  hu- 
man system,  was  attempted  during  the  earliest  period  of 
the  world.  Says  Le  Clerc  :  "  Le  premier  homme  a  et6 
en  un  certain   sens  le  premier  Medecin." 

When   Man's    nature    was    changed    from    the    Divine 
image  in  which  he  was  created,  the  sentence  was  passed  upon 
him,  "  Dying,  thou    shalt  die'' ;    but    though    now   subject 
to.    pain    and     sickness,    he    was    still    permitted    by    his 
benevolent  Creator  to    use  the  powers  of  his  mind  for  the 
alleviation  of  his  suffering.     He  would,  naturally,  seek  for 
the  balm  that  would  heal,  as  well  as   for   the   fruit  which 
would  nourish,  his  frail  body,  and,  although  fallen  from  the 
high  estate  in  which  he  was  created,    we  can  not  imagine 
him  to  be  fallen  so  low  as  to  keep,  as  a  secret  in  his  own 
bosom,  any  discovery   which   he   made  fraught  with   bless- 
ing to  the  afflicted.      No,  this  is  a  depth  of  baseness  and 
inhumanity  reserved  for  a  later  day  1     Every  new  discovery 
"would  be  carefully  handed  down  to  succeeding  generations, 
until,  when  men  had  "increased  exceedingly  on  the  earth,** 
and  the    different    avocations    of  life   were   instituted,   the 
knowledge   of   remedies  and    their  application,  became  the 
office  of  particular  individuals;  and  so,   a  class  of  Physi- 
cians arose. 

However  it  may  have  been   among  the    antediluvians. 


Address  to  Medical  Graduates  of  the  University.  69 

we  have  ample  evidence  of  the  existence  of  this  class, 
at  an  early  period  of  the  world's  present  history.  Proba- 
bly amongst  the  Egyptians  the  earliest  progress  was  made, 
in  this  as  in  other  branches  of  learning.  The  Egyptian 
physicians  were  an  order  of  Priests.  The  people  were 
Buperstitious,  and  it  was  natural  that  they  should  look  to 
the  ministers  of  religion  for  relief  from  diseases  which 
they  believed  to  be  the  direct  manifestation  of  the  dis- 
pleasure of  their  gods.  Amongst  the  Jews,  also,  we  have 
evidence  that,  at  an  early  period  of  their  national  exist*. 
«nce,  the  office  of  physician  was  established.  In  the 
lapocryphal  book  of  Ecclesiasticus  (supposed  to  have  been 
written  by  King  Solomon)  is  to  be  found  the  passage, 
*^  Honor  a  physician  with  the  honor  due  unto  him,  for 
the  Lord  hath  created  him,  for  of  the  Most  High  cometh 
'healing,  and  he   shall    receive   honor  of  the  king.'' 

But  it  is  to  Greece  that  we  must  look  for  the  origin  of 
the  rational  and  scientific  practice  of  Medicine,  and  for 
the  line  in  which  we  trace  our  descent.  Amongst  the 
O-reeks,  instruction  on  the  subject  of  Medicine  was  com- 
municated in  the  schools  of  Philosophy  and  the  Gym- 
nasia, as  well  as  in  the  temples  of  ^sculapius.  A 
knowledge  of  medicine  was  a  necessary  part  of  every  true 
scholar's  education.  The  writings  of  Plato  and  Aristotle 
abound  with  allusions  to  our  art,  and,  although  not 
practitioners,  they  were  well  versed  in  its  principles.  But 
as  Dr.  Watson  remarks,  "The  temples  of  ^sculapius 
were  the  first  great  foundations  of  medical  knowledge 
amongst  the  Greeks."  In  them  were  found  a  sacred 
'Order  of  men,  whose  whole  lives  were  devoted  to  the 
practice  and  teaching  of  the  healing  art.  Those  temples, 
apart  from  the  sacred  rites  and  religious  honors  paid  to 
s^scuLAPius,  Hygeia,  and  other  divinities,  resembled,  in 
-many  respects,  the  hospitals  of  the  present  day.  They 
were  very  numerous  throughout  the  Grecian  States.     They 


70  The  Peninsular  and  Independent. 

were  the  residences  of  the  Asclepiades,  or  Priest  Physi- 
cians, where  they  reared  their  families  and  trained  their 
sons,  and  were  resorted  to  by  the  afflicted  and  suf- 
fering for  relief  Along  the  walls  were  suspended  votive 
tablets,  recording  the  history  and  treatment  of  particular 
cases  of  disease.  The  situations  chosen  for  them  were 
well  adapted  to  promote  the  health  of  the  sick.  Says 
Dr.  Watson:  "They  usually  occupied  some  elevated  or 
retired  and  healthy  locality,  removed  from  the  city,  sur- 
rounded by  shady  groves,  or  in  the  neighborhood  of 
thermal  springs  or  medicated  waters.  They  were  sacred 
from  intrusion,  and  accessible  to  the  sick  only  after  suit- 
able preparation."  The  priests  received,  as  fees,  the  free- 
will offerings  of  the  sick.  Some  have  supposed  that 
those  physicians  were  restricted  in  the  exercise  of  their 
art  to  the  temples,  but  many  instances  are  on  record 
in  which  they  practiced  abroad.  Thus  the  Lacedemonian 
physicians  were  obliged  to  accompany  the  army.  Xeno- 
PHON  himself,  in  his  expedition  to  Persia,  was  accom- 
panied by  Ctesias  of  Cnidos,  who,  being  taken  pris- 
oner, subsequently  rose  to  great  eminence  as  a  physician 
at   the   Court   of  Persia. 

About  450  years  before  Christ,  was  born  Hippocrates, 
well  styled  Pater  Medicince,  a  son  of  the  Asclepiades, 
Trained  by  his  father  in  the  temple  of  Cos,  he  became 
famous  far  above  all  who  had  preceded  him.  He  form- 
ed a  new  era  in  Medicine.  Separating  it  from  the  re- 
ligious dogmas  and  speculations  of  the  old  schools,  ha 
set  aside  crude  theories  and  ignorant  hypotheses,  and  es- 
tablished incontestably  that  observation  is  the  sole  basis 
of  true  Medicine.  The  rapid  advancement  which  the 
practice  of  Medicine  made  in  his  hands  is  almost  incred- 
ible. He  removed  the  teaching  of  Medicine  from  the 
schools  of  Philosophy,  and  established  it  as  a  distinct 
department   of  practical   knowledge.      Himself    thoroughly 


Address  to  Medical  Graduates  of  the  University.  71 

educated  in  the  science  and  philosophy  of  his  day,  a 
bold  practitioner,  an  elegant  writer,  and  a  correct  observer, 
he  gave  such  an  impulse  to  it  that  he  may  almost  be 
considered  as  the  inventor  of  the  Healing  Art.  He  at- 
tained such  eminence  in  Athens  that  it  was  decreed  that 
he  should  be  honored  with  a  golden  crown,  and  that  all 
the  children  born  at  Cos  (his  native  island),  might  pass 
their  youth  at  Athens,  and  be  treated  as  Athenian  citi- 
zens. 

Gentlemen,  I  have  thus  alluded  to  the  early  history 
of  our  Profession  to  stir  up  your  enthusiasm,  and  remind 
you  of  the  responsibilities  you  have  to-day  assumed  as 
the  successors  of  a  long  line  of  heroic  men,  which  has 
been  perpetuated  from  the  days  of  the  great  Grecian  to 
our  own  times,  as  well  as  to  recall  you  to  a  grateful 
remembrance  of  the  privileges  you  have  enjoyed  in  the 
study  of  your  Profession,  sitting,  as  it  were,  at  the  feet 
of  the  prophets,  and  learning  from  them  the  accumula- 
ted experience  of  the  past,  as  a  guide  to  your  future 
career.  While,  on  behalf  of  the  Fraternity  of  Physicians, 
I  extend  to  you  a  cordial  welcome  as  members  of  that 
body,  permit  me,  at  the  same  time,  to  speak  with  you 
of  some  of  the  duties  and  responsibilities  upon  which  you 
are  about  to  enter.  What  I  may  say,  has  probably  been 
all  told  you  before  ;  but  a  few  words,  spoken  on  this  in- 
teresting occasion,  may  possibly  enforce  on  your  atten- 
tion important  truths,  even  if  they  are  familiar,  and 
clothed  in  homely  garb.  It  is  of  the  utmost  importance 
that  your  first  steps  should  be  taken  in  the  right  direc- 
tion ;  for  a  young  physician,  starting  wrong,  seldom  gets 
right  again. 

First,  Gentlemen,  I  hope  you  will  remember  that  you 
have  but  mastered  the  first  step  in  your  life  -  education. 
If  any  of  you  are  conceited  enough  to  think  that  you 
have  finished  it,  you  will  soon  find  out  your  mistake  ;  or 


72  The  Peninsular  and  Independent. 

it  will  be  the  worse  for  you,  if  your  conceit  hinders  you 
from  discovering  it.  I  suppose  you  will  all  acknowledge 
that  when  you  first  commenced  your  studies,  your  heads 
might  properly  have  been  ticketed  "To  Let/'  Now  some 
of  the  empty  apartments  have  found  good  tenants — I 
trust  permanent  occupants  —  that  will  always  be  ready  to 
pay  you  well  for  the  accommodation.  But  while  you  have 
got  the  basement  respectably  occupied,  if  you  are  wise 
and  prudent  landlords  you  will  just  be  the  more  anxious 
to  fill  the  best  rooms  and  upper  chambers,  with  good 
tenants.  You  have  laid  a  good  foundation,  build  care- 
fully the  superstructure,  and  let  not  that  which  has  cost 
you  so  much  labor  be  covered  up  with  rubbish  or  de- 
stroyed. 

Do  not  imagine  that  the  greatest  object  you  can  now 
accomplish  is  to  get  quickly  into  extensive  practice.  Be 
more  desirous  to  practice  well  than  much.  Let  every  day's 
experience  at  the  bedside  of  the  sick  add  to  your  knowl- 
edge. Learn  to  observe  closely,  to  reason  correctly,  and 
to  prescribe   wisely. 

It  is  of  great  importance  that  you  should  continue 
steadily  to  pursue  the  study  of  the  principles  of  your 
Profession.  If  you  neglect  to  do  so,  you  will  soon  come 
to  practice  as  the  sailor  who  navigates  a  ship,  ignorant  of 
the  laws  of  navigation.  A  physician,  to  do  his  duty, 
can  be  governed  by  no  general  laws.  Every  case  he  is 
called  to  treat  requires  independent  action,  and,  ignorant 
of  the  principles  of  his  Profession,  he  can  only  blunder 
in  the  dark.  Unless  you  maintain  habits  of  study,  you  will 
be  likely  soon  to  forget  what  you  already  know.  Your 
minds  are  now  well  disciplined,  and  it  will  be  easy  for  you 
to  prosecute  the  course  on  which  you  have  entered.  Fol- 
low out,  more  especially,  those  branches  of  learning  which 
bear  more  directly  upon  the  practice  of  Medicine,  but  you 
will  also   derive   great   advantage   and   pleasure  in  combin- 


Address  to  Medical  Graduates  of  the  University.  73 

ing  the  study  of  the  more  exact  sciences  and  general 
literature.  I  doubt  not,  very  many  physicians  would  ac- 
knowledge how  much  they  regret,  after  years  of  practice, 
that  they  did  not  pursue  their  studies  upon  leaving  the 
class-room.  Becoming  absorbed  altogether  in  practice,  and 
striving  to  accumulate  wealth,  they  forgot  much  of  that 
which  they  once  knew,  and  now  realize  that  they  are  mere 
machines,  their  minds  stunted,  and  their  highest  motive  auri 
sacra  fames.  In  such  cases,  the  attempt  to  go  back  and 
start  anew   is   difficult   and   irksome. 

There  is  probably  no  course  of  study  in  any  depart- 
ment of  learning,  either  in  this  country's  or  in  European 
Universities,  so  severe  and  exacting  as  that  prescribed 
for  students  of  Medicine,  in  our  Colleges.  And  say  of 
American  Medical  Colleges  what  they  please,  they  have 
produced  a  class  of  men,  who,  as  a  whole,  have  been 
unsurpassed  in  usefulness,  skill,  and  energy,  by  any,  or 
in  any  country,  in  the  world.  But,  Gentlemen,  I  know  that 
when  you  find  in  the  retirement  of  your  homes,  that  the 
excitement  which  enabled  you  to  apply  yourselves  with 
such  energy  has  passed,  there  will  be  a  tendency  to  ease  and 
indolence.  You  have  climbed  the  first  hill  of  the  moun- 
tain range.  After  struggling  up  its  rugged  sides  manfully 
and  bravely,  will  you  be  content  to  sit  down  on  its  grassy 
table -land  top,  satisfied  with  the  limited,  though  beautiful 
view  ?  Will  you  be  enticed  by  the  sweet  rest,  to  be  con- 
tent to  pluck  the  few  flowers  around  you,  only  to  be  so 
lulled  by  the  repose  as  unconsciously  to  slide  down  again 
to  your  starting  point.?  Kather,  I  pray  you,  look  onwards 
and  upwards.  One  eminence  after  another  rises  before 
you:  climb  steadily  and  hopefully  on;  you  will  be  well 
rewarded  for  your  toil.  Be  not  discouraged  because  you 
can  never  reach  the  highest  peak ;  the  higher  you  climb 
the  more  glorious  the  vision  ;  and  when  you  realise  that 
the   mountain   top  is  infinitely  beyond   your   view,    up   to- 


74  The  Peninsular  and  Independent. 

wards  God,  may  your  aspirations  be  drawn  out  after  a 
participation  in   His  glory ! 

Although  it  is  highly  proper  that  physicians  should 
be  well  remunerated  for  their  services,  yet  if  you 
mean  to  practice  only  for  the  sake  of  making  money, 
you  will  be  slaves,  and  fools  too.  For  if  your  talents 
will  enable  you  to  get  rich  with  23ractice,  and  ^  this  be 
your  only  aim,  you  would  attain  it  more  easily  and  cer- 
tainly in  other  employments.  If  you  practice  with  a 
proper  regard  for  the  welfare  of  your  patients,  with  a 
noble  aim  and  purpose  towards  the  general  good,  with  an 
enjoyment  of  the  luxury  of  mental  cultivation,  and  an 
appreciation  of  the  delights  of  increasing  knowledge,  then 
your   toils   will   be   lightened,  and   the  drudgery    removed. 

I  am  sure  you  will  look  with  abhorrence  upon  the 
mercenary  practice  of  warranting  cures  for  stipulated  sums 
of  money.  It  has  truly  been  said,  by  one  in  ancient 
times,  that  ^^  Medicine  is  the  noblest  of  professions,  but 
the  meanest  of  trades." 

The  position  which  you  occupy  in  society,  will  depend 
very  much  upon  your  own  character.  Mankind  will  natural- 
ly respect  a  physician.  The  office  is  one  calculated  to  call 
forth  their  gratitude,  and  if  a  physician  does  not  stand 
high  in  the  respect  and  esteem  of  those  around  him,  it  is 
his  own  fault.  If  you  lower  yourselves  to  familiarity  with 
the  rude  and  immoral,  do  not  be  surprised  if  you  are 
classed  amongst  them.  Gentlemen,  strive  not  only  to  be 
wise  and  prudent  practitioners,  but  also,  to  take  such  a 
position,  as  will  ensure  the  respect  and  esteem  of  the 
community  around  you.  Kemember  that  if  you  lower  your 
own  reputation,  you  injure  yourself  and  disgrace  your 
Profession.  Be  not  only  competent  physicians,  but  be 
every  inch  gentlemen.  Avoid,  I  pray  you,  as  you  would 
an  enemy,  all  attempts  to  draw  you  into  bar-room  friend- 
ships.     Does   it    not   make  the  ears  of  a  respectable  man 


Address  to  Medical  Graduates  of  the  University.  '75 

tingle  when  he  hears,  as  he  passes  in  the  village,  or  on 
the  corners  of  the  streets  in  the  cities,  recognition  of  the 
Doctor  in   low   and   vulgar  familiarity. 

Be  courteous  to  all  men — rich  and  poor  alike. 

Let  your  learning,  your  integrity,  your  morality,  and  (I 
would  do  violence  to  my  conscience  were  I  to  omit),  your 
Christianity,  mark  you  out,  not  only  as  good  physicians^ 
but  as  honest  men  and  useful  citizens. 

The  success  of  an  army  depends  upon  every  soldier 
acting  as  though  his  country's  honor  depended  upon  his 
undaunted  valor ;  and  so,  Gentlemen,  are  you  required  to 
act  on  behalf  of  your  Profession.  As  we  have  no  legal 
enactments  to  guarantee  our  status,  or  protect  our  inter- 
ests, and  as  all  that  is  necessary  to  constitute  a  Doctor 
ostensibly  is  the  ability  to  procure  a  shingle  with  the 
name  on  it,  it  becomes  more  imperative  on  each  one  of 
us  to  maintain  such  a  position  as  will  elevate  the  Pro- 
fession. You  go  before  the  public  with  credentials,  than 
which  there  are  none  higher  or  more  honorable  in  the 
land  :  see  to  it  that  you  do  not  tarnish  the  fair  fame  of 
Ann  Arbor. 

No  other  Profession  requires  such  a  comprehensive 
mind.  In  other  learned  professions  there  are  fixed  stand- 
ards to  which  appeal  may  be  made,  by  which  the  practitioner 
is  to  be  guided  ;  and  a  knowledge  of  them  may  be  at- 
tained with  certainty,  by  dint  of  arduous  study.  But  in 
Medicine  we  have  no  such  simple  authority.  The  phy- 
sician is  required  to  rest  on  his  own  judgment,  and  to 
bring  all  his  knowledge  to  bear  upon  an  endless  number 
of  points.  You  can  pursue  the  study  of  Medicine  by  con- 
sidering every  disease  separately,  but  in  practice  you  will 
find  the  symptoms  complicated  in  endless  variety,  which 
no  system  can  include,  and  the  greatest  discernment  is 
required   to   enable  you  to  come  to  correct  conclusions. 

Let  me  guard  you,  young  physician,  against  presump- 


7Q  The  Peninsular  and  Independent, 

tion.  Know  that  your  power  is  limited.  Many  have  start- 
ed with  vain -glorious  and  ignorant  ideas  of  their  power- 
In  their  pride  they  have  thought,  that  every  disease  must 
fly  at  their  approach.  If  a  little  experience  does  not 
soon  humble  their  pride — if  such  persons  do  not  speed- 
ily see  their  error — the  consequence  is  likely  to  be  that 
some  time  they  will  turn  a  complete  somersault,  and  be 
loudest  in  proclaiming  the  '^Old  School  Practice,"  as 
they  call  it,  a  "humbug";  still  too  proud,  too  ignorant 
to  know,  that  the  "humbug"  was  in  themselves,  and 
not  in  the  practice.  On  the  other  hand,  let  the  remem- 
brance that  a  higher  power  than  yours  disposes  of  events 
keep  you  from  self-reproach  when  disease  terminates  fa- 
tally. I  have  known  some  excellent  men,  of  over -sensitive 
dispositions,  render  their  lives  miserable,  and  unfit  themselves 
for  practice,  by  unjust  reflections  upon  their  own   acts. 

Need  I  warn  you,  Gentlemen,  to  have  nothing  to  do 
with  Quacks  .^  Avoid  them  as  you  would  a  poisonous 
reptile,  and  be  very  careful  to  give  no  occasion,  to  be 
thought  like  them.  Do  not  even  condescend  to  argue 
with,  or  oppose  them ;  for  in  so  doing  the  slime  may 
stick  to  your  own  fingers.  Have  nothing  at  all  to  do 
with  them  professionally  or  socially,  whatevei  be  their  name 
— whether  followers  of  the  more  crude  systems  which  have 
sprung  up  amongst  ourselves,  or  the  dreamy,  stupid  im- 
postures  of  Europe. 

Kemember  that  the  term  "'Allopathic  Physician"  was 
applied  to  us  by  those  who  wished,  by  so  doing,  to 
bring  us  down  to  their  own  level.  It  is  a  nickname,  a 
slander,  a  falsehood ;  and  he  who  is  content  to  be  so 
called — he  who  does  not  spurn  the  name  as  an  insult 
— deserves  to  be  ranked  with  the  Quacks.  Says  Dr.  Wood, 
in  his  admirable  Address  before  the  Americ&-n  Medical 
Association,  "I  say  again  we  are  not  Allopathists — we 
are  simply  regular  practitioners  of  Medicine,  claiming  to  be 
honest  and  honorable  ;  in  other  words,  to  be  gentlemen." 


Address  to  Medical  Graduates  of  the  University.  77 

There    are    some    features    common    to    all    forms    of 
quackery,    and    they    may    sometimes   be   found    to    char- 
acterize  those  who  do   not   openly  join   the   ranks   of  the 
charlatan.      It   would   be    well    for   the    Profession   if  the 
line   of    demarcation   between    the    regular    physician]  and 
empiric  was  more  marked.     There  are  those  who  nominal- 
ly  belonging   to  us,  are  head  and  shoulders  with  the  em- 
pirics,   and   it   is   a   pity   that   their   feet   are   not  so  also. 
Gentlemen,    let  me  warn  you   against  even  the  appear- 
ance of  evil  in  this  matter.     With  the  class  of  open  quacks, 
be  they  knaves  or  simple  ignoramuses,  you  expect  to  hear 
boasting   and   bragging    to    any    extent ;     the    relation    of 
marvelous    cures,    and    the    infalibility    of    their    systems. 
These  inflated  stories  are  their  stock  in  trade,  and,  however 
disgusting,    from  them  it  is   expected.      But   any  thing  of 
this  character  in  a  physician,  is  disgraceful  and  hurtful. 

I  know.  Gentlemen,  that  now,  with  your   minds  fresh- 
stored  with  proper  ideas  of  practice,  and  with  the  lessons  of 
high-toned  professional  conduct,  which  have  been  impress- 
ed  upon  your   minds  by  your  Professors,    still    ringing   in 
your  ears,  you  scorn  the  very  thought  of  allowing  quacke- 
ry, in  any  shape,  to  influence  you.     You  ask,  "  Am  I  a  dog 
to  do   this   thing  .?"      But   allow   me  to  remind  you,  that 
the  temptation  will  be  great.     The  bold  and  false  language 
in  which  the  empiric  parades  himself  before  the  public,  his 
power  to  cure  diseases,  the  certainty  of  his  remedies,   the 
warranting  of  cures,  has  created  a  public  sentiment  which 
every  physician  finds  difficult  to  strive   against,  and  which 
every  honest   one   must   lament,    even   when   it  results   in 
unwarranted  praise.     For  he  knows  that  those  persons  who 
are  continually  in  the  habit  of  speaking  of  the  Doctor  hav- 
ing cured  diseases,  will  be  just  as  ready  to  say,  if  occasion 
offers,  that  he  killed  his  patient.      He  will  often  feel  that 
the  praise  is  as  loathsome  as  the  blame  is  unjust. 

Gentlemen,  avoid  the  habit  of  asserting  your  power  to 


Y8  The  Peninsular  and  Independent. 

cure    disease.      If   necessary,    give   your   patients,  or   their 
friends,  the  strongest  assurance   of  your  favorable  opinion; 
and  this  is  all  that,  in  any  case,  you  can  do  as  true  men. 
Even  the  mildest  forms  of  disease  will  sometimes  baffle  the 
skill  of  the  physician,  and  fatal  results  will  sometimes  occur 
when  the  closest  observation  failed  to  detect  the  cause,  or 
to  give  warning  of  the  approach  of  death.      Let   no   man, 
however  much  learned,  assume  the  attributes  of  the  Deity, 
and    say    ^^I    can    cure'';    and   let   none  rob  his  Maker  by 
saying  "  I  have  cured."     He  that  indulges  in  such  language 
is  a  quack,  whatever  his  name,  and  wherever  you  find  him. 
A  bragging,  boasting  physician  is  an  absurdity.     No  really 
intelligent  and   honest  man,    a  student  in  any   department 
of  learning,  can  be  a  boaster  ;  for  the  highest  elevation  of 
human  intellect  will  but  serve    to    make    the    discovery   of 
how  little  man  can  know  on  this  side  of  the  grave.     When 
he  has  climbed  the  highest  and  struggled  the  hardest,   he 
will  but  realise  that  he  can  only  pierce  the  outer  crust  of 
knowledge,  and,  instead  of  boasting,   he  will  feel  his   own 
littleness,  and   prostrate   himself  in  humbleness   before  his 

GrOD. 

No,  Gentlemen,  I  am  quite  sure  that,  if  you  continue 
to  advance  in  your  studies  —  if  you  continue  to  be  actua- 
ted by  proper  motives — and  aim,  as  honest  men,  to  do 
all  that  lies  in  your  power  to  relieve  the  suffering,  and 
promote  the  welfare  of  your  patients,  you  will  never  be 
quacks,  hypocrites,  or  braggarts. 

Your  demeanor  towards  the  dupes  of  quackery  must, 
of  course,  be  different  from  that  which  is  necessary  to- 
wards those  wlio  practice  it.  Amongst  the  former  you  will 
sometimes  find  men  whom  you  are  bound  to  respect  and 
esteem.  Is  is  almost  unaccountable  how  some  men,  having 
a  character  for  shrewdness  and  intelligence,  will  allow 
themselves  to  be  imposed  upon  by  the  veriest  quack.  But 
while    you    respect  them,  be  on  your  guard   never   to   be 


Address  to  Medical  Graduates  of  the  University.  10 

betrayed  by  them  professionally.  Do  not  argue  and  debate 
witb  them  ;  let  them  distinctly  understand  that  you  wish 
to  have  nothing  to  do  with  them  professionally,  that  you 
can  not  alternate  with  a  charlatan  as  their  physician.  You 
will  find  that  many  persons  can  not  understand  your  posi- 
tion. They  have  been  led  to  believe  that  the  different 
forms  of  quackery  and  regular  practice,  are  just  different 
systems  of  treatment^ — all  alike  good — sometimes  one  is 
best  and  sometimes  the  other  !  One  pathy  versus  another 
pathy — one  pathy  for  children,  another  pathy  for  adults — 
the  one  if  the  sickness  is  slight,  the  other  if  it  is  severe. 

Now,  Gentlemen,  if  you  are  wise,  and  respect  yourselves 
as  you  ought,  you  will  put  a  stop  to  all  this  nonsense, 
so  far  as  you  are  concerned.  The  fact  is,  that  the  less 
you  have  to  do  with  people,  who  have  once  run  after  ab- 
surdities, the  better.  They  are,  I  was  about  to  say,  like 
a  runaway  horse,  never  to  be  trusted  again ;  but  the  re- 
semblance to  this  animal,  except  in  a  few  cases,  is  not 
striking.  Such  a  horse  has  usually  a  great  deal  of  natural 
spirit,  high  mettle  ;  he  is  a  noble  animal,  but  has  been 
badly  trained  :  while  amongst  the  crowd  of  followers  of  every 
system  of  quackery,  although  you  may  find  good,  honest, 
and  upright  men,  and,  I  am  sorry  to  say,  too  often 
Christian  men,  yet,  I  think  they  are,  usually,  unstable 
and  fickle -minded.  A  fitter  comparison  would  be,  that 
other  member  of  the  equine  race  which  is  for  ever  in- 
clined to  go  backwards,  and  which,  insignificant  though 
it  be,  if  you  are  not  on  your  guard,  will  do  you  an 
injury. 

Whilst  you  refuse  to  argue  with  these  people,  you 
should,  at  the  same  time,  be  always  ready  to  explain 
to  any  one  your  position.  You  should  acquaint  your* 
selves  with  the  different  systems  of  deceit  and  charlatanry, 
to  be  able  to  explain  to  those  seeking  information,  what 
they  really  are.       Some .  men    have   been  enticed  into  a 


80  The  Peninsular  and  Independent, 

belief  of  these  systems  for  a  time,  by  arguments  and 
well -managed  impostures,  who,  when  their  eyes  are  open- 
ed to  see  that  they  have  been  dupes  of  cheats  or  fools, 
learn   to  appreciate   true   science. 

Endeavor,  Gentlemen,  at  all  times,  to  be  not  only 
skillful  in  combating  disease  and  relieving  suffering,  but 
also  to  exert  a  healthful  moral  influence  in  your  prac- 
tice. There  is  a  lamentable  amount  of  moral,  as  well 
as  physical,  degradation  fostered  in  our  communities  by 
the  character  of  the  language  employed,  and  the  schemes  re- 
sorted to,  by  the  charlatan  ;  and  this  is  greatly  aided  by 
the  popular  medical  and  physiological  works  scattered 
broadcast   amongst   the  people. 

Gentlemen,  be  above  resorting  to  any  of  the  practices 
which  savor  of  deceit  or  humbug,  to  obtain  practice.  Do 
not  assume  airs  of  importance  and  greatness,  which,  how- 
ever calculated  to  impress  the  ignorant  for  a  time,  will 
only  cause  you  to  be  laughed  at  by  intelligent  people. 
The  use  of  technical  phrases  and  long -sounding  names, 
in  talking  to  your  patients,  will,  in  the  end,  only  beget 
contempt.  Be  respectful  in  your  deportment,  plain  in 
your  language,  kind  in  your  inquiries,  and  firm  in  your 
requirements  ;  above  all,  do  not  fawn  and  flatter,  to  ob- 
tain practice.  Flunkeyism  is  disgusting  anywhere,  but 
especially  in   a   physician. 

In  your  intercourse  with  your  brethren,  strive  to  be 
ever  honorable.  Professional  and  personal  rancor  amongst 
physicians,  has  done  incalculable  injury  to  the  Profes- 
sion. As  you  regard  your  own  reputation,  as  you  value 
your  own  happiness,  and  as  you  desire  to  uphold  the 
honor  of  your  Profession,  avoid  ungentlemanly  conduct 
towards  your  brethren.  There  is  one  short  injunction  of  the 
inspired  pen  which  should  ever  guide  you — "^e  courte- 
ous." In  a  word.  Gentlemen,  pursue  the  course  which  will 
lead  you  to  honor  and  respect  as  well  as  success. 


Address  to  Medical  Graduates  of  the  University.  81 

I  know  that  I  express  the  sentiinents  of  every  one  in 
this  assembly,  when  I  wish  you,  with  all  my  heart,  God- 
speed !  Speed  then.  Doctors  of  Medicine,  on  your  honora- 
ble but  arduous  career  !  May  you  be  enabled  to  meet 
the  trials  of  life  bravely,  and  its  difficulties  with  undaunt- 
ed hearts,  cheered  by  the  smiles  of  fortune,  an  approving 
conscience,  the  esteem  of  the  good  and  the  gratitude  of 
those  to  whose  welfare  you  devote  yourselves.  Beyond  all 
pecuniary  recompense,  and  in  the  midst  of  services  which 
money  can  never  remunerate,  may  the  blessings  of  him 
who  was  ready  to  perish,  come  upon  you.  At  the  close 
of  a  useful,  beneficent,  and  honored  life,  may  the  loving 
arms  of  the  Gieat  Physician  receive  you.  And  on  that 
coming  Coronation -day  which  will  surpass  all  that  has 
preceded  it  as  Eternity  is  greater  than  Time,  may  you 
receive  crowns  of  rio^hteousness   which   never   shall   fade  ! 


-•♦  •- 


ART.  YIII.— Foreign  Body  in  the  Air  Passages. 


By  W.  H.  Johnson,  M.  D. 


On  the  20th  of  February,  1854,  I  was  called  to  visit  the 
son  of  Mr.  E.  P.  Hall,  aged  about  seven  years.  The  case 
presented  the  following  conditions,  to  wit :  Fever  of  the 
remittent  form,  differing  in  some  respects  from  the  ordin- 
ary type  of  fever  then  prevailing,  as  it  seemed  more  symp- 
tomatic than  endemic.  On  inspecting  the  thorax,  the 
right  side  of  the  chest  was  found  anteriorly  to  be  much 
distended — raised  probably  about  three -fourths  of  an  inch 
above  its  fellow.  Auscultation  detected  a  very  bad  vesic- 
ular murmur  at  each  respiratory  movement,  not  unlike 
the  resonance  heard  in  interlobular  emphysema.  The 
sound,  on  percussion,    was    morbidly   clear,    otherwise   the 

Vol.  11.- F. 


82  Tlie  Peninsular  and  Independent, 

lung  was  apparently  healthy.  The  same  tests  applied  to  the 
left  side  discovered  a  dissimilar  set  of  symptoms,  though 
I  was  unable,  on  percussion,  to  detect  the  least  devia- 
tion from  the  normal  state.  In  aj^plying  the  ear  to  the 
left  side  of  the  chest,  I  found  greatly  diminished  respir- 
atory movement.  But  little  of  the  respiratory  murmur 
was  heard,  yet  the  lung,  on  percussion,  emitted  a  clear 
healthy  sound  throughout  its  whole  extent.  There  was 
no  cough ;  nor  was  there  any  soreness  complained  of  or 
admitted.  This  was  the  state  in  which  I  found  the 
patient.     Now,    What   was   the   matter  ? 

At  the  time,  after  the  most  careful  examination  I 
failed  to  satisfy  my  own  mind  as  to  the  cause  of  this 
unusual  pathological  condition,  and  misdiagnosed  the  case. 
By  an  accident,  I  believed  the  right  lung  had  become 
emphysematous  by  the  infiltration  of  air  in  the  cellular 
texture,  and  that  the  left  had  become  impaired  in  its 
functions  by  the  same  cause  that  affected  the  right, 
though  affected  very  differently.  From  the  slight  mucus 
mZe,  discovered  on  presenting  the  ear  to  the  chest  pos- 
teriorhjj  I  inferred  the  diminished  action  was  due  to  the 
collection  of  mucus  of  extreme  tenacity  about  the  bifur- 
cation  of  the    trachea. 

The  accident  alluded  to,  was  this  :  Two  days  pre- 
vious to  my  visit,  the  boy,  playing  at  school,  alleged 
that  he  had  swallowed  a  pencil,  and  was  seized  with 
spasmodic  periods  of  coughing,  and  went  home.  The 
parents  assured  me  that  the  spasms  occurred  frequently 
for  the  first  four  hours  succeeding  the  accident,  and  were 
very  violent,  nearly  amounting  to  strangulation.  After 
this,  the  violence  of  the  cough  abated,  or  stoj^ped  alto- 
gether ;  and  so  slight  was  the  disturbance,  that  but  little 
attention  was  given  to  the  case  for  forty -eight  hours  af- 
terwards. From  this  circumstance,  the  mitigation  of  all 
the   violent   symptoms,    and   the    quietude    of    more    than 


Johnson  on  Foreign  Body  in  the  Air  Passages.        83 

ordinary  intelligent  parents,  I  was  induced  to  believe  that 
the  pencil,  if  inhaled,  had  never  passed  the  chink  of  the 
glottis,  but  had  secured  a  lodgment  at  the  superior  por- 
tion of  the  trachea,  giving  rise  to  those  violent  spas- 
modic movements,  and  had  been,  by  them,  unobserved  by 
the  parents,  thrown  out,  leaving  the  pathological  condition 
alreadv   described. 

The  patient  was  put  on  a  treatment  of  the  milder 
alternatives  with  diaphoretics,  and  continued  on  the  same, 
with  slight  modifications,  for  about  eight  days.  This 
was  attended  with  an  abatement  of  the  acute  inflam- 
matory action  and  a  diminution  of  fever.  There  was 
still  no  soreness  in  the  least  complained  of.  A  tonic 
course  of  treatment  was  now  substituted,  and  persisted  in 
for  another  eight  days,  as  the  diminished  strength  of  the 
patient  seemed  to  require,  though  there  was  a  slight  exa- 
cerbation of  fever  occurring  every  day. 

In  the  mean  time  my  mind  was  undergoing  a  change 
in  relation  to  the  case,  arising  from  the  persistence  of  the 
fever  and  the  local  difficulty.  It  was  possible  —  yes,  highly 
probable  —  that  a  foreign  substance  had  plugged  up  the 
left  bronchus,  giving  rise  to  all  the  phenomena  there  pres- 
ent. If  a  foreign  substance  was  thus  lodged,  it  must  be 
the  pencil.  On  the  11th  of  March  following,  at  my  request, 
the  patient  was  seen  by  Dr.  W.  B.  Southard,  to  w^hom 
I  had  confided  mv  fears.  He  too,  came  to  the  conclusion 
to  which  I  had  arrived.  The  local  symptoms  were  still 
,  the  same  as  when  I  first  saw  the  patient,  except  the  slight 
respiratory  murmur  and  the  mucus  rdle^  which  had  entirely 
disappeared.  The  patient  was  subsequently  seen  by  Drs. 
Cornell  and  Osburn.  Tracheotomy  was  suggested,  but 
deemed  improper. 

The  tonic  treatment,  with  nutricious  diet,  was  pursued 
up  to  28th  of  March.  From  this  time,  but  little  treat- 
ment was  had.     So  far  there  was  no  especial  change  in  the 


84  The  Peninsular  and  Independent. 

condition  of  the  patient,  except  that  of  gradual  emaciation. 
On  the  22d  of  April,  being  at  play  with  a  little  sister, 
and  having  occasion  to  laugh  heartily,  the  patient  was 
again  seized  with  very  violent  spasmodic  coughing.  By  a 
series  of  well-directed  movements  on  the  part  of  the  mother, 
such  as  shaking  the  boy  violently  with  his  head  in  a  de- 
pending position,  with  many  other  indescribable  manipula- 
tions, a  slate  pencil,  measuring  three -fourths  of  an  inch  in 
length,  and  two  lines  in  diameter,  was  thrown  from  the 
lungs,  after  remaining  in  the  bronchial  tube,  as  described, 
for  sixty-four  days. 

Since  the  expulsion  of  the  pencil,  the  boy's  health  has 
been  steadily  improving.  I  have  constantly  kept  my  eye 
on  the  case,  and  have  quite  recently  examined  the  little 
fellow.  He  is  quite  active,  and  seems  to  develop  physically 
equal  to  other  children  ;  but  I  find  still  upon  him  almost 
precisely  the  same  condition  of  both  lungs  that  I  found  on 
visiting  him  fL\Q  years  ago.  The  right  lung  is  still  per- 
forming rnuch  the  larger  portion  of  respiration,  while  the 
action  of  the  left  remains  very  weak,  and  respiration  by  it 
is  very  feebly  performed.  * 

There  has  not,  at  any  time  since  the  accident,  been  the 
least  soreness  of  either  lung. 

Albion,  March  18th,  1859. 


•  •  • 


ART.  IX,— 5ew  Methocls  of  Resuscitating  Stillborn  Children,  and  of 
Restoring  Persons  apparently  Drowned  or  Dead. 


By  M.  A.  Patterson,  M.  D.,  Tecumseh,  Mich. 

In  corroboration  of  the  views  presented  in  the  sub- 
joined extract,  it  may  be  proper  to  state  that,  for  se- 
veral years,  it  has  been  our  practice  to  treat  cases  of 
stillborn   children    by   directing   an   attendant    to    support 


Patterson-  on  New  3Iethods  of  Resuscitating,  €$:c.       85 

the  head  of  the  child,  with  its  neck,  at  times,  slightly 
inclined  backwards,  while  we  place  our  hands  high  in 
its  armpits  and  close  to  the  chest,  with  the  palms  up- 
ward and  under,  and  the  thumbs  over  its  shoulders ; 
positions  which  enable  us  to  raise  the  arms  of  the  in- 
fant to  the  requisite  height,  and,  at  the  same  time  to 
elevate  its  body  and  lower  limbs  nearly  or  quite  per- 
pendicular. When  this  is  done,  the  arms  of  the  child 
are  brought  rather  quickly  to  its  sides,  and  its  body  as 
quickly  to  a  sitting  posture.  These  motions  are  continued 
with  temporary  suspensions  ;  during  which  the  usual  pre- 
cautions to  remove  mucus  from  the  air  passages,  to  dash 
a  few  drops  of  cold  water  in  its  face,  and  to  stimulate 
the  nostrils  and  chest,  are  attended  to,  until  the  child 
cries,  which,  if  life  is  not  entirely  extinct,  usually  hap- 
pens in  a  few  minutes.  During  the  whole  process  of 
restoration  we  carefully  guard  against  the  loss  of  animal 
heat,  and,  occasionally,  we  have  found  it  necessary  to 
apply   this   method  while   the   child  was   in   a  warm  bath. 

If  the  hands  are  properly  placed,  the  required  motions 
may  be   made  without   the   slightest   injury  to   the   infant. 

The  effect  of  these  motions  upon  the  mechanism  of 
the  child  explains  the  modus  operandi  of  the  process 
without   a   word   of  comment. 

Whoever  has  seen  a  dying  person  "gasping  for  breath" 
will  comprehend  why  we  incline  the  head  gently  backwards. 

Our  friend  Dr.  Baldwin  has  used  this  method  sev- 
eral times,  with  perfect  success  ;  and  we  described  it  to 
Prof.  Palmer,  a  year  or  two  since,  who  promised,  on 
the  first  opportunity,  to  give  it  a  trial.  Whether  he 
has  had  occasion  to  test  its  utility,  we  have  no  present 
means  of  ascertaining,  as  he  is  now  on  his  way  to 
Europe.  Some  misgivings  as  to  its  novelty  prevented  an 
earlier  publication  of  this  "  discovery " -^— if  entitled  to  a 
name,    so   significant   when    truly   applied,    and    so    hack- 


86  The  Peninsular  and  Independent. 

neyed  as  ordinarily  used.  At  all  events,  the  present 
publication  will  serve  to  illustrate  the  correctness  of  Dr. 
Sylvester's  views,  whose  process  in  part,  is  similar  to 
the  "ready  method'"  which  we  have  thus  briefly  de- 
scribed. 

In  a  pamphlet  recently  published,  Dr.  Sylvester  argues  that  the 
postural  method  of  Dr.  Marshall  Hall  for -the  restoration  of  persons 
who  have  been  asphyxiated,  does  not  displace  more  than  a  fraction  of 
a  cubic  inch  of  air  from  the  lungs,  that  the  expansion  of  the  thorax  is 
limited  to  that  which  results  from  from  the  mere  elasticity  of  the  tissues 
compressed  during  the  rotatory  efforts,  and  that  the  contraction  and 
expansion  are  confined  to  one  side  of  the  chest.  He  points  out  other 
objections,  such  as  that  the  contents  of  the  stomach  and  oesophagus  may 
pass  into  the  windpipe,  or  that  the  patient's  face  may  be  bruised  and 
his  neck  twisted  by  the  prolonged  movements,  to  which  may  be  added 
that  ribs  are  sometimes  fractured,  as  we  have  ourselves  witnessed.  The 
author  proposes  to  make  the  first  effort  of  the  asphyxiated  individual 
an  *?ispiratory  one,  by  using  the  arms  as  handles  to  open  and  close 
the  chest. 

To  determine  the  effect  produced  on  the  contents  of  the  thorax,  by 
the  proceeding  advocated  by  Dr  Sylvester,  he  introduced  a  glass  tube 
into  the  trachea  of  a  corpse ;  this  was  connected  by  a  flexible  tube  with 
a  glass  horse-shoe  tube  containing  a  small  quantity  of  colored  fluid, 
which  was  maintained  at  the  same  level  in  both  legs.  "The  height 
of  the  column  having  been  first  carefully  noted,  the  arms  of  the  subject 
were  raised  and  steadily  extended  upwards  by  the  sides  of  the  head,  so 
as  to  draw  up  the  shoulders,  and  put  the  pectorals  on  the  stretch,  ele- 
vate the  ribs,  and  consequently  enlarge  the  cavity  of  the  chest.  The 
result  was,  that  the  fluid  in  the  bent  tube  rapidly  fell,  and  so  consider- 
ably as  to  recede  high  up  in  the  leg  of  the  instrument  nearest  the  body; 
that  is  to  say,  the  tendency  to  a  vacuum  produced  in  the  chest  drew 
the  air  into  the  lungs;  the  shoulders  and  arms  were  next  pressed  down 
upon  the  sides  of  the  chest,  and  immediately  the  fluid  rose  as  much 
above  its  usual  level  in  the  further  leg  of  the  apparatus  as  it  did  in 
the  foregoing  experiment." 

Dr.  Sylvester  has  tested  the  effect  of  the  rotatory  plan  by  the  same 
instrument,  which  demonstrates  that  while  a  small  quantity  of  air  is 
expelled  from  the  thorax  by  compression,  only  so  much  can  be  drawn 
in  as  will  occupy  the  space  created  by  the  elasticity  of  the  ribs.  He 
concludes:  ''1.  That  by  his  mode  of  procedure  the  actual  capacity  of 
the  chest  was  increased,  and  air  drawn  into  the  lungs  by  the  constrained 
action  of  the  muscles  of  respiration  upon  the  movable  walls  of  the 
thorax ;  2.  That  expiration  was  produced  by  pressing  the  arms  and 
shoulders  down  upon  the  sides  of  the  chest." 


Patteeson  on  JSFeio  Methods  of  Resuscitating^  c0c.       87 

The  author  points  out  that  his  method  is  characterized  by  an  actual 
enlargement  of  the  cavity  of  the  chest,  owing  to  elevation  of  the  ribs 
above  their  ordinary  or  natural  level ;  this,  he  maintains,  is  not  eflfected 
by  the  Marshall  Hall  plan. 

Dr.  Sylvester's  suggestion  certainly  is  based  upon  sound  anatomi- 
cal and  physiological  principles ;  we  therefore  hasten  to  lay  it  before  our 
readers,  and  request  them  to  put  it  to  the  test,  without,  at  the  same 
time,  neglecting  such  other  precautions  with  regard  to  the  restoration 
of  warmth  by  friction  and  dry  clothing,  of  drawing  forward  the  tongue 
to  prevent  the  larynx  from  being  closed,  and  the  like,  as  the  author 
very  properly  points  out. 

[British  Medico- Chirtcrgical  Review. 


88 


The  Peninsular  and  Independent. 


ART.  X,  —  Meteorological  Register  for  Month  of  March,  1859. 

By  L.  S.  Horton,  House  Physician  to  U.  S.  Marine  Hospital. 

Altituda  of  Barometer  above  the  level  of  the  sea,  697  feet.     Latitude,  42^24' N.-   and 
Longitude.  82°58'AV.  of  Greenwich. 


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CO-^vO-r^-<*lrti'*Tj<>0»Ou:) 


CslCOCOOO'^CDiOOO: 

CO  co_coj:m  CO  CO  -^  CO ^ 

C^  Tti  '^  Tt<  O  i^  CO  C<1  ^^ 

■^  -rtl  •<*  -"i^  CO  TH  TtH_CO  co_ 

fM  CM  CD  O  C<I  00  t-  ^  1^ 

CO  CO  CO  CO  CO  CO  Tt<  CO  gsl 

"uTTciT^fN  ?N  CO  00  00  r-i 
COCOCOCOCOtJHCOCOCO 


(MOCO-^C<1C0  1^CO(M'>1C<I 
COCOCOCOCOOQC<JCOCOCOCO 


COCOOO'^iOCOOOTt^t^-^b- 
COrtlrtl-^COCOO^tiCOCOCO 


CO  -M  O  C-1  O  C^l  (M  »>!  CO  ■>*  CO 

CO  CO  CO  CO  CO  (M  CO  CO  CO  CO  co 

O  O  t—  t^  CO  Ci  Ci  CO  lO  -"^"^ 

cocococococmC'ItHcococo 


■1  <M  >0  lO  C<1  CO  O  t^ 
lOOiO-^-^cDlOCOCO 


l^COOOr^(M(MiOCOCOI^-H 
(MCOCOCOCOCOCOCOCOCOCO 


OOOi-HCOCO-*C55-^^>— I 

coThiTtt'<*-<*TtiTj<coco 


00  o  oq  to  >o  lO  00  o  o  (M  ^ 

OOSt^t^OOOOt^QOOiOOOO 


'NOiOOiOOOtOC^l 
O'-tOOOOOOOOOCO 


CDO-lr-iOC<lCOCD(MOOObcD 
coco:DcOTiHcocDto-^cOTtt 

lO  00  'tl  CO  uO  -^  CO  00  to  CO  b-. 

cocococococ<icccocococo 

"Cll^)  tO  -^  00  to  (M  -t-  'c^o'^ 
00CiC5t--^00CD<NO(MI>» 


o^cooooooooooooooocooo 

C<1  -M  C<J^  G<l  (M  C^  CI  (M  'M  (M 

to  "O'tO  1— 'to  OO  ^  to  O  fM  Ol 

Oo:)t^t^c:t^i--.i^OOOt^ 


OiCSlOOOJCiOOOOOOOO 

OiOO^OO-t^OCS-^" 
O'-HOt^OCiOOOOO 


OOOOOOOOOOOOCOOOOOOOOO 
(MG<l<MC<ie^'Mg^(MC<lC<ie<» 

<:500O.-<OOtOO(MC<l-* 
0000OC0-*05C0Tt<O<MC0 


OiOOOOOOOOOOOOOOCiOOOO 
<M  (M  C^l  C<l  (M  (M  ^  Cvl  CM  -M  C-l 


CTiCTSOiOOOiOOOOOOOO 


OOOOOiOOOOOOOOOOOOOOOO 


o  >o  >o  O  00  'M  o  o  o  o  r^ 
OC5500t^OOOOt^OOOOOOO 


'+toooooo^::50i0>o 

CSOOt-i—tOOt—OS 


cooooiOicoajcoioooqto 


GiOOOOOOCCOOOOnOOiOOOO 


OOCiGiOO<3iO^COP^OO 
Oq'MfM'MtMCSICq'MfM 


OOOOCOOOOOQOOOCOOCQOOO 


i-)(MCOTHtOCOl-^00050i-H 


'MCO-^tOCOt—  OOCiO 
T-iT-lTHrHr-lrHr-l,-tC<l 


_i  r-i  --v-i  -*  vO  CD  I"-  CT;  Oi  (^  t-H 
(NC<JC<J(N<NCNC<JC<J(NCOCO 


iibli^gra^lital  |lu0rir. 


A  TREATISE  ON  FRACTURES.  By  J.  P.  Malgaigne,  Chirurgien  de 
THopital  Saint  Louis,  Chevalier  de  la  Legion  d'Honneur  et  du  Merite 
Militaire  de  Pologne,  Membre  de  I'Academie  Royal  de  Medicine. 
With  one  hundred  and  six  Illustrations.  Translated  from  the  French, 
with  Notes  and  Additions,  by  John  H.  Packard,  M.  D.  Phila- 
delphia :  J.  B.  Lippincott  Sr.  Co.     1859. 

This  belongs  to  a  class  of  books  which  we  esteem  so  highly 
as  to  trust  that  the  list  may  be  continually  augmented. 
It  is  so  utterly  impossible  to  do  any  thing  like  justice  to 
the  subject  of  Fractures  in  the  body  of  an  ordinary  woik 
upon  a  general  system  of  Surgery,  that  a  work  like  the 
above  will  be  duly  appreciated  by  the  student  who  aspires 
to  some  thing  more  than  a  mere  knowledge  of  the  method 
of  recognizing  and  treating  Fractures.  The  treatise  in 
question  should  prove  unusually  acceptable  to  the  Profes- 
sion ;  and  in  this  country,  where  the  tendency  to  hold  the 
surgeon  responsible  in  dollars  and  cents,  for  a  perfect  job, 
seems  to  have  obtained  general  prevalence,  it  would  seem 
that  there  is  abundant  inducement  for  study  of  the  sub- 
ject of  which  it  treats. 

The  work  is  well  arranged,  and  constitutes  a  complete 
treatise.  The  cuts  are  printed  on  heavy  and  fine  paper, 
which  hardly,  however,  atones  for  their  separation  from  the 
subject  which  they  illustrate.  Cuts  should  be  interspeised 
through  the  body  of  the  work.  G. 


90  The  Peninsular  and  Independent. 


A  TREATISE  ON  THE  VENEREAL  DISEASE.  By  John  Hunter, 
F.  R.  S.;  with  Copious  Additions  by  Dr.  Philip  Ricord,  Surgeon  of  the 
Hopital  du  Midi,  Paris,  etc.  Translated  and  edited  by  Freeman 
BuMSTEAD,  M.  D.,  Lecturer  on  Venereal  Diseases  at  the  College  of 
Physicians  and  Surgeons,  N.  Y.;  Assistant  Surgeon  to  the  N.  Y.  Eye 
Infirmary.  Second  Edition,  containing  a  Resume  of  Ricokd's  recent 
Lectures  on  Chancre.      Philadelphia:    Blanchard  &  Lea.      1859. 

There  was  great  propriety  in  associating  together  the  views 
of  Hunter  and  Ricord  in  the  first  edition  of  the  above 
work  ;  and  however  much  we  may  differ  from,  or  however 
precisely  we  may  coincide  with,  the  views  of  these  two  great 
men,  we  can  entertain  but  one  opinion  as  to  their  influence 
in  regard  to  the  great  body  of  truth. 

The  present  edition  contains,  in  a  condensed  form,  an 
addition  to  the  notes  of  the  former  issue,  derived  from  the 
published  notes  of  Ricord's  Lectures  on  Chancre,  by  M. 
Tournier  ;  an  addition  which  enhances  not  a  little  its 
value.  G. 

THE  DRUGGIST.  A  Monthly  Newspaper  for  the  Trade.  No.  1,  Vol.  I. 
Cincinnati,  Ohio. 

A  NEATLY  printed  paper,  of  quarto  size,  containing  16 
pages,  to  .be  issued  monthly,  under  the  editorship  of  Henry 
E.  FooTE,  M.  D.,  assisted  bv  a  number  of  Pharmaceutists 
in  different  parts  of  the  Union. 

We  remark,  in  the  present  No.,  the  pen  jottings  of 
Wayne,  on  Pharmacy,  in  which  he  gives  some  examples  of 
ancient  Pharmaceutical  Preparations,  taken  from  an  old 
London  Dispensatory,  of  1696,  in  which  the  excrementitious 
matters  of  horses  and  cows,  and  substances  of  like  medici- 
nal value,  are  tortured  by  maceration  and  distillation  into 
essences  of  wonderful  power  in  disease.  We  feel  thankful 
that  modern  science  does  not  find  such  uses  for  fresh  cow 
dung.  Won't  Mr.  Wayne  give  us  some  more  examples 
from  that  old  book  (which  we  think  must  be  quite  out  of 


Slhlio graphical  Record.  91 

print)  ?  We  think  they  will  convince  the  minds  of  the 
most  obtuse  that  the  Grolclen  Age  of  Pharmaceutical  Sci- 
ence was  not  in  the  past. 

Apropos  of  old  books,  we  have  one,  entitled  '^  An  Essay 
for  the  Keformation  of  the  London  Pharmacopoeia,"  dated 
1746 ;  which  is  filled  with  marginal  notes,  in  manuscript, 
which  notes  denote  a  scientific  knowledge  and  skill  on  the 
part  of  the  writer  that  the  present  age  would  hardly  give 
him  credit  for,  and  containing  suggestions  in  relation  to 
formulae  which  have  not  been  improved  upon  since. 

But  to  return  to  the  '^  Druggist."  At  the  low  price 
of  the  paper,  and  popularity  which  such  publications  assume 
among  Dealers  in  Medicine,  we  may  safely  predict  for  it  a 
large  and  profitable  circulation.  It  has  been  placed  on 
our  exchange  list.  F.  S. 


^YxtGxhl  geprtm^nt. 


Retraction  of  the  Cincinnati  Lancet  and  Observer. 

It  will  be  recollected  that  in  our  March  No.  we  referred 
to  the  slanderous  allegations  of  the  above  journal  against 
our  friend  and  colleague,  Prof.  Sager,  and  ourself,  charging 
us  with  assuming  a  title  which  did  not  belong  to  us.  After 
quoting  the  language  previously  used  by  it,  the  Lancet  and 
Observer  says : 

"Now  it  seems  that  this  statement  is  not  true,  and  we  therefore 
make  the  correction  and  the  amende  honorable  to  Dr.  P." 

It  further  says : 

"Wishing  to  do  no  man  injustice,  more  particularly  to  injure  the 
hard-earned  reputation  of  an  honorable  physician,  we  will  also  correct 
our  statement  in  regard  to  Dr.  Sager.  .  .  We  regret  our  error,  and 
have  thus  donf  all  we  can  to  correct  it." 

This  seems  fair  and  satisfactory;  but  it  is  usually  the 
case  that  those  who  have  been  the  subjects  of  wrong  from 
others,  are  more  or  less  pursued  by  their  traducers  in  the 
same  spirit,  and  in  the  article  from  which  we  have  ex- 
tracted the  above  explicit  retractions,  there  are  some  state- 
ments and  insinuations  which  indicate  that  this  case  will 
not  prove  a  very  brilliant  exception. 

We  do  not  propose  to  bandy  words  with  the  Lancet 
and  Observer,  but  there  are  a  few  statements  in  this  article 
which,  once  for  all,  require  a  little  elucidation.      It  says  we 


Editorial  Department.]  93 

wrote  a  very  threatening  letter,  demanding  their  authority 
for  the  statement  they  had  made,  threatening  with  a  suit 
for  lihel  unless  correction  was  made.  What  was  written 
on  that  point  was  to  this  effect: 

"No  honorable  man  can  rest  quietly  under  such  an  imputation;  and 
you  will  not  be  surprised  that  I  ask  of  you  the  most  explicit  retraction 
and  apology,  giving  it  as  wide  currency  as  the  charge.  .  .  I  do  not 
propose  having  what  purports  to  be  a  respectable  medical  journal  thrust 
before  me,  at  home  or  abroad,  with  such  a  statement  in  it,  without  being 
able  to  show  a  retraction,  or  some  other  evidence  that  it  has  been  pro- 
perly resented." 

Not  one  word  was  said  about  a  libel  suit.  This  was 
probably  what  the  editors  feared,  not  what  we  said. 

We  did  not  demand  the  authority  on  which  the  slan- 
derous statement  was  said   to  be  based.      The  letter  said: 

*'I  have  no  desire  to  raise  insignificance  to  the  dignity  of  contempt, 
but  it  would  seem  necessary,  to  shield  yourse^lves  from  the  imputation  of 
unprompted  and  the  most  malicious  falsehood  published,  and  therefore 
libellous,  that  you  should  reveal,  at  least  to  me,  the  source  of  informa- 
tion from  which  you  made  the  charge." 

This  was  all  on  this  point;  and  it  is  but  just  to  all 
parties  to  say,  that  in  their  letter  to  us  they  state, — 

"We  received  a  communication  from ,  unsolicited  on  our 

part,  from  which  we  took  the  remark  so  offensive  to  you."      [We  omit 
the  name,  only;  the  italic  word  is  theirs.] 

It  is  proper,  in  this  connection,  further  to  say,  in  order 
that  their  correspondent  be  not  censured  more  than  he 
deserves,  that  they  admit  in  the  article  they  did  not  give 
his  precise  words,  though  their  letter  would  clearly  indicate 
they  did.      The  editorial  says: 

"It  is  probably  true  that,  as  we  did  not  use  the  exact  language  of 
our  correspondent,   more  may  have  been  expressed   than  we  intended." 

Whether  their  correspondent  was  properly  echoed  or  not, 
we  can  only  judge  from  the  letter  and  the  editorial  article. 


94  The  Peninsular  and  Independent. 

We  only  Iznow  that  the  Lancet  and  Observer  uttered  the 
slander,  and  has  now  retracted  it.  The  jiarties  must  settle 
between   themselves   the  share   each   has  had   in  the  work. 

One  thing  more:  The  editors  of  the  Lancet  and  Ob- 
server accuse  us  of  insulting  them  by  saying  they  did  not, 
themselves,  write  the  editorial  in  their  January  No.  This 
seems  to  be  regarded  by  them  as  our  greatest  offense. 
What  we  said  was,  that  we  could  not  believe  that  either 
of  the  editors  (connected,  as  one  or  both  of  them  were, 
with  a  school  requiring  not  nearly  as  mu^h  of  students  as 
our  school  does)  wrote  the  article.  We  thought  it  impos- 
sible that  they  could  have  originated  their  own  stultifica- 
tion—  that  they  could  abuse  us  on  their  own  instigation 
for  opposing  requirements  for  entering  our  college  which 
neither  they  nor  any  other  school  in  the  country  apply 
even   to   graduates. 

In  this,  according  to  their  statements,  we  were  mis- 
taken. We  must  admit,  then,  that  they  did  originate 
their  own  stultification  by  vehemently  condemning  in  us 
what  they  practice  to  a  much  greater  extent  themselves. 
We  honestly  believed  they  had  been  tampered  with,  as 
we  knew  others  had  been  —  we  thought  we  had  internal 
evidence  that  unsolicited  communications  had  been  sent 
them  —  and  we  intended  the  remark  which  they  pretend 
to  resent,  rather  as  an  excuse  than  a  reproach.  As  they 
take  it  otherwise,  we  retract  our  charitable  opinion.  It 
was  only  an  opinion,   and  exjDressed   as   such. 

We  have  now  done  with  the  Lancet  and  Observer ^  and 
are  inclined  to  think,  also  with  its  unsolicited  corres- 
pondent. To  the  latter,  if  in  the  future  he  will  but 
keep  out  of  our  path,  we  can  afford  to  say  as  Uncle 
Toby  said  of  the  troublesome  fly  which  he  caught,  and 
which   most   others   would   have   crushed, 

"Go,  poor  devil,  get  thee  gone  *  *  *  this  world  is  surely  wide 
enough  to  hold  both  thee  and  me."  A.  B.  P. 


Editorial  Department.  95 

Tlie  Cultivation  of  MecHcioal  Plants. 

When  the  extent  of  our  'dependence  upon  foreign 
sources  for  important  and  invaluable  elements  of  our 
Materia  Medica  is  considered,  the  question  of  home  cul- 
ture of  foreign  medical  plants  assumes  no  mean  import- 
ance  in   an   industrial   and   commercial   point   of  view. 

It  is  now  generally  conceded  that  the  cultivation  of 
indigenous  medicinal  plants  improves  their  therapeutic 
powers ;  an  improvement  as  marked  nearly  as  that  in- 
duced by  careful  culture  in  products  of  the  uutricious 
plants  which  form  so  large  a  portion  of  our  food.  It 
follows,  as  a  natural  consequence,  that,  due  regard  being 
paid  to  climatic  influences,  to  position,  and  to  soil,  many 
of  the  substances  now  imported  in  enormous  quantities, 
and  at  high  rates,  for  the  supply  of  ths  Drug  trade, 
might,  with  advantage,  be  cultivated  in  our  own  country. 
This  would  open  new  fields  of  industry  and  profit,  and 
tend  directly,  by  mcreased  production,  to  lessen  the  cost 
to   consumers. 

The  successful  cultivation  of  the  narcotic  plants  is 
instanced  in  the  botanic  gardens  of  the  Messrs.  Tilden, 
and  in  the  farms  of  the  several  Shaker  societies  of  the 
Eastern  States,  who  suppl}^,  to  some  extent,  our  markets 
with  pressed  herbs,  &c.  Valeriai^a  officinalis ^  of  excellent 
quality,  is  quite  largely  cultivated  in  New  England,  and 
even  in  this  State  to  an  extent  worthy  of  placing  it 
above  being  termed  an  experiment.  The  successful  cul- 
ture of  the  Liquorice  root  in  this  country  is  almost 
established. 

It  is  gratifying  to  notice  that  the  Agricultural  Bureau 
of  the  Patent  Office  has,  in  connection  with  its  impor- 
tations of  foreign  seeds  and  plants  for  distribution  among 
agriculturalists,  undertaken  the  task  of  importing  those 
of  medicinal  value  also,  with  the  view  of  enabling  it,  con- 
jointly with  the  efforts  of   botanists,  and  especially  of  the 


96  ,    The  Peninsular  and  Independent. 

American  Pharmaceutical  Association,  to  introduce  into 
successful  culture  here  the  most  esteemed  and  valued  me- 
dicinal products  of  other  countries.  It  is  impossible,  we 
think,  to  overestimate  the  value  which  may  accrue  in  com- 
ing time  to  our  country  by  these  efforts  now  being   made. 

The  Agricultural  Bureau  has  already  reported  the  com- 
plete success  of  the  introduction  of  the  Quercm  subra,  or 
Cork  oak  ;  and  when  it  is  considered  we  pay  to  Europe  a 
quarter  of  a  million,  annually,  for  the  item  of  corkwood 
alone  the  commercial  value  of  others  may  be  imagined. 

The  olive,  prune,  ^g,  zante  currant,  liquorice  root,  opium 
poppy,  and  fenugreek,  have  also  been  experimented  with, 
but  with  a  success  not  yet  fully  determined,  owing  to  the 
want  of  botanical  gardens  or  experimental  farms,  and  to 
some  extent,  doubtless,  to  ignorance  on  the  part  of  those 
having  charge  of  the  experiments,  of  the  proper  natural 
requirements  of  plants  under  their  charge. 

Within  our  boundaries,  are  found  the  greatest  possible 
variety  of  soil  and  climate,  and  no  obstacle  seems  to  exist 
in  introducing  medicinal  plants,  except,  perhaps,  the  want 
of  willing  and  interested  parties  to  undertake  the  culture 
of  them  while  success  is  yet  an  experiment. 

In  connection  with  the  culture  of  foreign  medicinal 
plants,  we  see  no  reason  why  that  of  many  of  our  import- 
ant indigenous  ones  might  not  profitably  be  undertaken. 
With  few  exceptions,  the  demand  for  the  most  valuable  of 
them  is  supplied  from  those  districts  where  their  natural 
growth  is  most  plentiful ;  these  supplies  being  very  irregu- 
lar, the  rates  of  value  in  market  are  equally  so.  In  the 
case  of  the  peppermint,  and  of  some  few  others,  cultivation 
has  proved  exceedingly  profitable.  Why  not  supply,  by 
the  same  means,  the  demand  for  the  more  important  of 
indigenous  roots,  herbs,  seeds,  &c.,  for  which  demand,  we 
must,  in  a  measure,  thank  the  so-called  school  of  eclectic 
physicians  ? 


JEcUtorial  Department.  ,07 

Dr.  ZiNA  Pitcher,  of  our  city,  has  determined  to  take 
an  initiatory  step  in  this  direction,  by  establishing  a  bota- 
nical garden  in  the  grounds  of  the  U.  S.  Marine  Hospital 
at  this  place,  for  the  purpose  of  affording  an  agreeable 
occupation  for  the  convalescents  of  the  house,  and  more 
directly  to  afford  an  opportunity  to  all  who  are  interested, 
to  study  the  botanical  characteristics  of  that  portion  of  the 
rich  flora  of  our  State  considered  of  value  in  medicine.  At 
the  same  time,  it  is  intended  to  determine  the  practica- 
bility of  their  successful  cultivation  as  agricultural  products. 

The  Physician  and  Pharmaceutist,  while  confined  to  their 
duties,  may,  if  they  possess  any  taste  for  botany,  readily 
determine  for  themselves  the  practicability  of  cultivating 
home  or  foreign  medicinal  plants,  by  experiments  in  their 
ofiQces  and  stores,  upon  single  specimens  —  abundance  of 
which  may  be  found  at  one's  very  doors  —  the  care  of  which 
will  be  amply  rewarded  by  the  gradual  perfection  of  them 
from  small  beginnings,  affording  no  small  amount  of  pleasure 
and  intellectual  profit.  F.  S. 

langenbeck's  Tracheotomy  Hook. 

This  useful  little  instrument  consists  of  two  parallel 
teuacula :  one  of  which  is  firmly  fixed  into  a  handle ; 
the  other  is  attached  to  its  side  by  a  hinge,  and  is 
worked  either  by  a  lever  or  a  small  set  screw.  Pres- 
sure upon  the  lever  separates  the  points  of  the  tena- 
cula.  In  the  operation  of  tracheotomy,  the  trachea  being 
exposed,  and  the  points  of  the  tenacula  being  set  apart 
by  the  screw"-  at  a  distance  of  one -quarter  of  an  inch, 
the  instrument  is  firmly  inserted  into  the  trachea,  which 
is  thus  securely  held  while  the  surgeon  makes  the  neces- 
sary incision  into  that  organ,  between  the  two  tenacula. 
Pressure  upon  the  lever  now  separates  the  edges  of  the 
incision,   and   opens  wide   the  wound   in   the   trachea,  ad- 

Vol.  II. -Q. 


98  The  Peninsular  and  Independent. 

mitting  at  once  the  air,  and  facilitating "  the  introduction 
of  the  tube.  The  practical  surgeon  will  see  that  the 
instrument  can   be    used   in   many   other   operations. 

G. 


Suspension  of  tlic  Clinical  School  connected  with  the  Medical  De- 
partment of  the  University  of  Micblgau. 

With  the  sanction  of  the  members  of  the  Board  of 
Eegents,  the  undersigned  gives  notice  that  the  course  of 
instruction  in  practical  medicine,  hitherto  given  at  the  hos- 
pitals in  Detroit,  during  the  recess  of  the  term  for  didactic 
tuition,  will,  for  the  present  year,  be  suspended. 

There  is  reason  for  believing  that  this  suspension  will 
be  only  temporary :  that  the  cause  of  it  is  financial,  and 
that,  when  re-established,  it  will  be  placed  on  a  broader, 
more  substantial  and  enduring  basis. 

Z.   PITCHER, 

Clinical  Instructor. 

[We  are  requested  to  state,  in  connection  with  the 
above  notice,  that  Medical  Students  of  adequate  prepara- 
tion can  have  access  to  the  hospitals  during  the  summer, 
the  same  as  if  the  Clinical  School  was  not  suspended. 

F.  S.] 

The  Laryngoscope, 

The  object  of  this  instrument  is  to  expose,  by  re- 
flection, the  parts  about  the  mira  glotidis.  Small  metal- 
lic mirrors,  introduced  into  the  posterior  portion  of  the 
pharynx,  for  the  purpose  of  reflecting  the  image  of  the 
parts  to  be  inspected,  constitute  the  main  feature  of  the 
apparatus,  but  for  the  purpose  of  throwing  a  strong  lip-ht 
into  the  fauces,  a  concave  metallic  mirror,  through  which 
is   a  peep   hole,  is   fixed   to   the   surgeon's   forehead.     The 


Editorial  Department.  99 

surgeon,  now  placing  himself  before  his  patient  and  a 
strong  gas  light,  attempts  to  throw,  by  means  of  his  now 
brilliant  caput,  a  flood  of  light  down  the  patient's  throat, 
while  he,  at  the  same  time,  peeps  through  his  little  peep 
hole. 

Of  the  exact  amount  of  utility  embodied  in  this  ap- 
paratus we  will  attempt  no  estimate,  preferring  to  let 
others   pursue   infinitessimal   investigations.  G. 


Medical  ConTention  for  RcTising  the  Pharmacopceia  of  the  U.  S. 

The  Medical  Convention  for  Kevising  the  Pharmacopoeia, 
which  met  at  Washington  in  May,  1850,  provided  for  as- 
sembling a  Convention,  for  the  same  purpose,  in  the  year 
1860,  by  the  following  resolutions  : 

1st.  The  President  of  the  Convention  shall,  on  the  first  day  of  May, 
1859,  issue  a  notice  requesting  the  several  incorporated  State  Medical 
Societies,  the  incorporated  Medical  Colleges,  the  incorporated  Colleges  of 
Physicians  and  Surgeons,  and  the  incorporated  Colleges  of  Pharmacy, 
throughout  the  United '  States,  to  elect  a  number  of  delegates,  not  ex- 
ceeding three,  to  attend  a  general  Convention,  to  be  held  at  Washington^ 
on  the  first  Wednesday  in  May,  1860. 

2d.  The  several  incorporated  bodies,  thus  addressed,  shall  also  be 
requested  by  the  President  to  submit  the  Pharmacopoeia  to  a  careful 
revision,  and  to  transmit  the  result  of  their  labors,  through  their  dele- 
gates, or  through  any  other  channel,  to  the  next  Convention. 

3d.  The  several  Medical  and  Pharmaceutical  bodies  shall  be  further 
requested  to  transmit  to  the  President  of  this  Convention,  the  names  and 
residences  of  their  respective  delegates,  as  soon  as  they  shall  have  been 
appointed,  a  list  of  w^hom  shall  be  published,  under  his  authority,  for  the 
information  of  the  medical  public,  in  the  nevrspapers  and  medical  journals, 
in  the  month  of  March,  1860. 

In  accordance  with  the  above  resolutions,  the  under- 
signed hereby  requests  the  several  bodies  mentioned  to 
appoint  delegates,  not  exceeding  three  in  number,  to  re- 
present them  in  a  Convention  for  Ee vising  the  Pharma- 
copoeia of  the  United    States,  to  meet  at  Washington    on 


100  The  Peninsular  and  Independent, 

the  first  Wednesday  in  May,  1860  ;  and  would  also  call 
the  attention  of  these  bodies  to  the  second  and  third  re- 
solutions,   and    request    compliance    with    the    suggestions 

therein  contained. 

GEO.   B.  WOOD, 

President  of  the  Convention  of  1850. 
Philadelphia,  May  1st,  1859. 


[The  above  notice,  received  from  Prof  Geo.  B.  Wood, 
Philadelphia,  explains  itself  The  importance  of  the 
Decennial  Kevision  of  the  Pharmacopoeia  peculiarly  com- 
mends its  careful  attention  to  medical  corporations  and  as- 
sociations, delegates  for  which  will  legally  constitute  the 
Convention  to  meet  in  1860.  We  hope  that  the  influence 
of  those  medical  institutions  west  of  the  Alleganies  will 
be  more  apparent  in  the  sitting  of  1860  than  it  has  been 
hitherto.  F.  S.] 


SHut^lj  ^riiths,  g^bsttatts,  &t. 


Dr.  Lampe  on  Cases  of  Premature  Birth  Artifleially  Produced. 

Translated  from  the  German,  by  Dr,  O.  D.  Palmer,  from  the    "  Oesterreichiscke  Zeit^ 

ichriftfur  Praktische  HeilkundeP 


The  resort  to  art  for  the  purpose  of  procuring  premature  delivery,  is 
with  us,  in  the  country,  of  seldom  occurrence.  This  arises  partly,  be- 
cause the  physicians  themselves  can  hardly  justify  the  necessity  for 
dealing  in  flesh  and  blood,  and  ^partly  because  the  opposing  prejudice  of 
the  public  is  an  obstacle  difficult  to  overcome.  The  more  seldom  the 
occurrence,  so  much  the  more  urgent  is  the  duty  of  those  who  have 
witnessed  results  to  contribute  their  experience.  This  must  excuse  me 
for  requesting  for  a  short  time  the  honored  reader's  attention,  to  the 
relation  of  the  following  cases,  which  have  occurred  in  my  own  practice. 
Mrs.  M.,  aged  about  thirty  years,  of  middle  stature,  of  extraord- 
inary obesity,  has  borne  four  living  children  naturally,  and  has  had  one 
abortion.  In  each  of  the  four  births,  the  delivery  was  accomplished 
with  very  great  difficulty.  It  would  seem  from  the  remarkable  indica- 
tions in  her  case,  that  in  the  same  proportion  as  she  gains  in  corpulency 
(which  at  length  has  grown  to  deformity)  her  children  increase  in  rela^ 
tive  size  and  weight.  Thus,  though  the  fourth  child  was  born  alive 
after  unspeakable  suffering,  yet  with  the  fifth  she  was  subjected  to  an 
extremely  tedious  operation  with  the  forceps,  which  consumed  many 
hours,  as  well  as  my  own  strength  almost  to  perfect  exhaustion,  before 
she  was  delivered  of  a  dead  child.  The  child  had  the  unusual  weight 
of  eleven  pounds.  Previous  to  this  last,  and  consequent  to  an  abortion 
Mrs.  M.  had  underwent  a  severe  attack  of  MetrorrTiagia^  and,  later, 
following  the  delivery  by  the  forceps,  she  had  passed  through  an  ex 
tremely  dangerous  puerperal  process ;  so  that,  from  these  circumstances 
and  with  the  evident  increase  of  difficulty  at  each  succeeding  parturition 
she  had  become  very  fearful  of  any  new  pregnancy.  Therefore,  in  view 
of  the  very  great  dangers  to  which  the  mother  might  be  subjected  at 
he  next  time,  the  very  natural  requisition  was  made  upon  me  to  furnish 


102  The  Peninsular  and  Independent. 

some  means  by  which  the  anticipated  difficulty  could  be  prevented, 
promised,  at  the  next  pregnancy,  that  I  would  procure  an  artificial  pre- 
mature delivery,  to  which  resort  I  felt  perfectly  entitled,  after  having 
myself  witnessed  the  antecedents.  The  ominous  pregnancy  was  made 
manifest  in  1845,  and  I  resolved,  at  a  suitable  period,  to  institute  the 
means  for  a  premature  labor.  I  selected  for  this  purpose  the  thirty- 
sixth  week  of  gestation.  There  were,  at  that  time,  besides  rupturing  the 
membranes,  the  Brunhaussen  "Method"  of  Klag,  which  consisted  in- 
troducing compressed  sjmnge  into  the  os  uteri^  as  the  safest;  and 
Schcellek's  method,  of  tamponing  the  vagina^  as  the  most  simple  and 
least  injurious  known.  I  made  use  of  both  at  the  same  time.  As  an 
introduction,  a  warm  bath  was  first  prepared,  and  borax  given  at  long 
intervals,  whilst  I  placed  in  the  vagina  a  tampon  made  of  pieces  of 
soft  linen,  and  used  in  such  a  manner  as  to  exercise  a  moderate  pres- 
sure on  the  vaginal  walls.  Thence  arose  sickness  of  stomach,  great 
restlessness,  and  a  sensation  of  uneasiness,  generally.  Whilst  the  tam- 
pon was  removed  for  the  purpose  of  changing,  I  applied  a  local  vapor- 
bath.  Shortly  after  distinct  pains  were  perceived,  but  very  irregularly. 
After  repeating  the  tampon  three  times,  these  came  on,  during  the 
evening  of  the  second  day,  stronger  pains,  and  the  os  uteri  was  dilated 
to  the  extent  of  one  inch  in  diameter.  At  this  time,  I  introduced  into 
the  open  mouth  of  the  womb,  a  piece  of  pressed  sponge,  made  in  form 
of  a  cone  for  the  purpose,  and  retained  it  there,  by  means  of  the  tam- 
pon, for  twenty-four  hours.  On  removing  it,  and  after  a  few  moderate 
pains,  the  membranes  were  spontaneously  ruptufed,  and  a  small  quantity 
of  the  waters  discharged.  I  now  put  all  in  readiness,  since  generally 
from  that  decisive  moment,  to  which  labor  had  been  brought  by  art, 
no  stand-still  was  longer  to  be  apprehended,  and  haste  was  not  neces- 
sary; on  the  other  hand,  the  patient  was  already  in  a  pretty  excitable 
state,  and  with  the  tumefaction,  and  great  sensibility  of  the  soft  parts, 
even  a  local  vapor  bath  would  not  be  sufferable. 

It  was  not  until  the  fifth  night  that  regular  bearing -down  labor 
pains  were  perfectly  established,  and  about  four  o'clock  in  the  morning 
the  spontaneous  birth  of  a  well  formed,  lively,  living  child  followed, 
coming  to  the  world  by  the  head  presentation.  The  placenta,  on  account 
of  a  partial  adhesion,  and  violent  flooding,  had  to  be  removed  by  the 
introduction  of  the  hand,  and  detaching.  The  patient  was  put  to  bed 
greatly  exhausted ;  her  recovery  very  slow  and  tedious,  and  after  a 
lingering  time  of  several  weeks,  she  still  had  to  undergo  an  attack  of 
pJdegmatia  alba.  The  child,  which  had  the  size  and  appearance  pro- 
portionate to  its  eight  months'  growth,  was  badly  affected  with  icterus^ 
on  which  diarrhcea  supervened,  and  could  only  be  properly  attended  to 
by  the  employment  of  a  nurse,  against  which  arrangement  the  heartlesa 
mother  was  at  first  strongly  opposed. 


Selected  Articles^  Abstracts^  <&c.  103 

I  confess  that  this  case,  from  the  obstinate  delay  of  the  uterus  in 
assuming  a  state  of  activity ;  from  the  extremely  lingering  course,  and 
long  duration;  from  the  many  disagreeable,  nay  highly  threatening 
symptoms,  and  the  unfavorable  accouchement  of  the  lying  -  in  woman, 
affords  anything  but  encouragement  to  a  repetition  of  this  method. 

Very  happily  for  me,  the  next  cases  demanding  interference,  for  the 
purpose  of  anticipating  the  period  in  which  parturition  is  usually  ac- 
complished, happened  just  at  the  time  when  Kiwisch  had  brought  into- 
vogue  the  warm  Uterine  douche.  It  had  been  generally  received,  and 
successfully  applied.  '  I  treated  two  cases  according  to  this  method.  The 
occasion  in  each  case,  was  contraction  of  the  pelvis  —  the  period,  the 
eighth  month.  As  the  two  cases  were  very  analogous  in  their  courses, 
and  afforded  nothing  of  particular  interest,  it  is  sufficient  to  state  that 
the  daily  application  of  the  '■'■uterus  douche^''''  repeated  four  times  in  a 
day,  and  continued  ten  minutes  each  time,  with  water  at  a  temperature 
of  30°  Reau.  (100"  Fahr.)  produced  labor,  followed  by  delivery  on  the 
second  day  spontaneously,  without  very  considerable  reaction,  —  both 
children  coming  to  the  world  alive,  and  fresh,  and  continued  living;  the 
mothers  both  passing  through  their  lying  -in  period  without  accident. 
By  the  favorable  results  in  these  two  cases,  I  had  acquired  confidence 
in  the  method  indicat'^d  above. 

This  method  had  been  generally  adopted,  but  it  could  not  fully 
maintain  its  famed  pretentions  to  precedence,  and,  as  was  to  be  ex- 
pected, new  methods  arose,  with  the  hope  of  supplanting  this  one,  or 
of  being  included  in  the  same  bounds  of  permanency  with  it.  These 
are  the  one  of  Cohen,  and  the  two  of  Scanzoni.  I  had  an  oppor* 
tunity  to  use  the  first  mentioned  during  the  present  year,  to  treat 
the  following  case,  which  I  take  this  occasion  to  report  somewhat  in 
detail : 

Madam  H.,  about  thirty -five  years  of  age,  of  small  stature,  but 
without  other  striking  symptoms  of  a  rachitic  habit,  was  delivered  by 
me  two  years  since,  in  a  normal  pregnancy,  by  perforating  the  cra- 
*nium  of  the  foetus.  Previous  to  my  resorting  to  this  means  she  had 
continued  in  labor  two  days  —  the  last  twenty -four  hours  was  after 
the  discharge  of  the  liquor  amnii ;  and,  according  to  the  testimony 
of  two  colleagues  who  had  preceded  me  in  the  case,  the  head  had 
been  wedged  in  the  pelvis  ten  hours  immovably.  On  a  searching 
examination  of  the  pelvis  I  ascertained  that,  though  perfectly  symme- 
trical in  form,  the  conjugate  diameter  was  but  three  inches.  The 
contraction  of  the  pelvis  in  its  most  important  diameter  was  increased 
still  more  by  the  inward  projection  of  the  superior  rim  of  the  pubic 
bones.  As  Mrs.  H.  found  herself  again  in  a  state  of  pregnancy,  in 
1856,  I  earnestly  represented  to  her  that,  if  she  wished  the  happi, 
ness  of  bringing  to  the  world  a  living  child,  it  could  be  accomplished 


104  The  Peninsular  and  Independent. 

only  by  means  of  a  premature  birth,  and  that  she  herself  could  only 
thereby  be  protected  from  the  mischances  of  a  difficult  delivery.  She 
assented  with  joy.  Her  gestation  proceeded  without  any  material  acci- 
dent in  its  normal  course,  and  the  only  thing  to  be  considered  was 
the  particular  point  of  time  when  the  accouchement  should  be  brought 
about.  Her  last  menstruation  took  place  about  the  middle  of  Octo- 
ber, 1856;  the  first  movement  of  a  quickening  was  perceived  in  the 
first  days  of  March,  1857.  I  therefore  selected  the  second  week  of 
June,  as  being  as  near  as  might  be,  the  thirty -second  week  of  ges- 
ation,  in  which  to  induct  premature  labor.  This  early  date  was  chosen 
as,  in  accomplishing  her  last  delivery  by  perforation  I  had  made  myself 
acquainted  with  the  whole  difficulty.  I  had  ascertained,  by  the  de- 
velopments of  a  child  of  medium  size,  whose  birth  had  been  opposed 
by  the  circumstances  already  related,  that  not  only  the  symphasis, 
but  the  whole  anterior  circle  of  the  pubes,  by  projecting  inwards 
Btrongl}'',  and  by  being  less  concave  than  usual,  had  narrowed  down 
the  entrance   of  the   pelvis. 

The  method  put  in  use  by  me  was  that  of  Cohen  modified.  On 
the  first  day,  I  applied  twice,  the  warm  uterus  douche^  continued  five 
minutes  each  time,  and  as  there  was  no  danger  in  delay,  I  awaited 
in  order  to  have  the  advantage  of  the  natural  'preparation  of  the  parts 
implicated  in  labor.  Following  the  repeated  application  of  the  douche, 
a  light  contraction  of  the  womb,  and  a  peculiar  seizing  of  the  im- 
pregnated female  with  a  sensation  of  lassitude,  was  perceptible.  On 
the  third  day  I  made  the  first  injections  into  the  uterus.  An  elastic 
catheter,  without  stylet,  was  put  in  use,  which  1  carefully  introduced 
through  the  orifice,  and  conducted  along  tho  inner  walls,  perhaps  three 
inches  high,  and  about  three  ounces  of  water  at  30"  Reaumer  was 
injected  through  it,  and  the  catheter  immediately  withdrawn.  A  small 
part  of  the  injected  water  flowed  away  directly,  and  in  the  second  hour 
thereafter  decided  pains  were  manifest,  returning  at  uniform  but  tolerably 
long  intervals.  After  the  second  injections,  made  half  a  day  later, 
the  pains  returned  at  shorter  intervals,  thus  deciding  their  character 
to  be  genuine  regular  labor  throes.  They  acted  so  forcibl}',  that  five 
hours  after,  in  a  regular  progress,  the  waters  were  discharged,  the 
birth  of  the  child  following  in  three  more  hours,  by  the  head  pre- 
sentation. The  whole  course  of  the  labor  was  so  regular,  that  it  was 
distinguished  by  no  indication  from  a  normal,  spontaneous,  labor,  at 
the  full  period  of  gestation.  The  child  exhibited  lively  action,  and 
cried  with  a  full  voice.  It  showed  the  size  and  developments  of  a  seven 
months'  child,  but  was  much  weaker  than  we  had  expected  it  to  be- 
The  parturient  esteemed  herself  even  happy,  in  comparison  with  her 
state  at  the  birth  of  the  first  child.  Then,  she  suffered  such  excru- 
tiation  and  martyrdom,  for  such  a  mournful  result:  now  her  labor  had 


Selected  Articles^  Abstracts^  dbc.  105 

been  so  easy,  and  so  soon  over,  affording  her  already  the  foretaste 
of  a  mother's  joys.  The  placenta  came  away  of  itself  in  about  ten 
minutes.  Her  accouchement  was  passed  over,  and  her  lying-in  ac- 
complished, without  the  least  thing  to  disturb  it.  She  left  her  bed 
on  the  tenth  day,  and  found  herself  impregnated  again  in  the  course 
of  a  few  weeks.  The  child  was  put  to  the  breast  of  a  wet-nurse, 
but  apparently,  in  spite  of  the  best  attention,  it  grew  so  little,  that 
I  soon  doubted  its  coming  through.  It  notwithstanding  reached  the 
age  of  nearly  five  months,  and  died  of  atrophy  without  an  attack  of 
any   disease. 

Though,  in  consideration  of  the  above  detailed  grounds,  I  can  not 
reproach  myself  with  having  chosen  a  too  early  point  of  time  in  which 
to  induce  labor,  yet  the  desired  result,  with  its  remote  consequence, 
and  the  knowledge  acquired  by  witnessing  the  course  of  the  last  par- 
turition, in  regard  to  the  relative  dimensions  of  the  pelvis  compared 
with  the  size  of  the  cliild,  in  this  individual  case,  are  very  suitable 
to  assist,  in  the  appointment  of  that  precise  point  of  time  at  a  future 
period.  This  is  a  question  the  decision  of  which  is  to  exert  an  in- 
fluence on  the  happiness  of  future  results,  in  all  time.  The  scale  pro- 
posed by  Stolz,  KiwiscH,  and  others,  for  the  purpose  of  determining 
the  time  for  inducing  premature  labor,  agreeable  to  the  relative  mea- 
surements of  the  head  and  pelvis,  is  certainly  not  proper  to  guard 
against  accidents.  It  appears  plausible  enough  in  theory,  but  is  so 
little  valuable  in  practice  that  at  every  elaborated  case  the  mocking 
voice  of  fame  echoes  in  the  ears  hie  Rhodus  —  hie  salta!  As  there  are 
generally,  in  the  minute  measurements  of  midwifery,  calculations  made 
for  particular  exceptions,  in  viv^,  and  as,  for  example,  one  tug  at  the 
forceps,  with  experienced  hands,  tells  more  a  thousand  times  than  the 
most  ingenious  pelvimetre  and  kephalometre  can  ever  tell,  so  it  is  in 
this  case  also ;  nothing  but  the  most  judicious  weighing  of  every  pos- 
sible influence  that  can  have  a  bearing,  at  the  moment  will  protect 
against  fatal   accidents,    though   never   wholly   insure   against   them. 

I  know  full  well  that  one  case  only  is  insufficient  to  furnish  data 
from  which  an  unprejudiced  opinion  can  be  pronounced  on  any  new 
process  in  the  practice  of  midwifery,  but  when  I  reflect  how  widely 
different  was  the  parturient  course  in  the  last  detailed  case  from  the 
one  that  immediately  preceded  it,  with  what  regularity  and  how  per- 
fectly analagous  to  the  spontaneous  and  timely  birth,  I  can  not  for- 
bear to  render  my  verdict  unconditionally  in  favor  of  the  method  of 
Cohen.  There  can  be  no  method  given  for  those  partially  experienced 
that  is  more  simple  —  none  more  easily  practiced,  or  more  little  dan- 
gerous than  this ;  and,  according  to  the  experience  hithtrto  collected 
( the  whole  number  of  cases  in  which  premature  birth  has  been  ef- 
fected by   Cohen's   method,   according    to  his   estimate,   rates  from  70 


106  Tlie  Peninsular  and  Independent. 

to  80),  there  is  none  that  exceeds  it  in  safety.  In  the  expression 
"little  dangerous"  there  should  not  be  associa|:ed  an  idea  of  total  want 
of  danger  in  the  process  of  procuring  premature  birth.  In  regard  to 
danger:  in  every  method  ever  discovered,  or  that  is  likely  ever  to  be 
discovered,  cavilers  can  point  to  unfavorable  cases.  Whoever  observes, 
with  impartial  eyes,  the  process  of  parturition  as  enforced  by  art,  and 
compares  it  with  the  natural  process,  the  difference  between  the  two  will 
not  escape  his  view.  In  the  former,  when  the  storm  of  reaction  com- 
mences, be  it  ever  so  mildly,  it  may  still,  in  comparison  with  the  natural 
action,  be  named  a. storm ;  and  there  is  a  time  when  any  one  predisposed  to 
deal  in  charms  would  willingly  invoke  a  power  to  banish  the  pain  -  spirits 
did  he  but  understand  the  magic  formulae  of  command.  Would  it  not  be 
wrong,  therefore,  if  the  operations  for  artificial  birth  were  undertaken  in  a 
dare-devil  manner,  at  least  with  the  same  indifference  that  many  Gyna- 
colleagues  (sage-femmes?)  make  incision  into  the  os  uteri,  as  a  masterly 
stroke  of  art  for  the  cure  of  sterility.  I  wished,  in  using  the  expression 
"little  dangerous  method,"  to  have  said  only  that  the  method,  when 
put  in  use  according  to  Cohen's  project,  with  necessary  care,  contains 
nothing  that  can  involve  directly  in  its  train,  dangerous  consequences. 
I  might  rather  have  recommended  the  uniform  use  of  flexible  tubes  instead 
of  the  tin  and  bone  ones  mentioned  by  Cohen,  a  modification  which 
Cohen  himself  has  proposed,  as  a  protection  against  the  danger  of  a 
false  passage  (i.  e.  between  the  decidua  and  uterus),  and  which  he 
recommended  on  a  more  recent  occasion,  when  Prof.  Grenser  and  Dr. 
Jack  communicated  to  him  the  unfortunate  cases  published  by  an 
over  precise  critic  {S.  MonatscKrift  fur  Geburtskunde,  Berlin,  1857). 
These  reported  cases,  in  my  view,  'are  as  little  attributable  to  the 
method,  as  many  unfavorable  accidents  in  the  various  obstetric  mani- 
pulations, even  when  they  are  carried  out  according  to  the  letter  of 
the  law,  if  are  neglected,  the  necessary  foresight  and  patience,  and, 
instead  of  these,  haste  and  violence  prevail.  The  adage,  '■'■Duo  si 
faciunt  idem,  non  est  idem,  suits  nowhere  better  than  here.  Nowhere 
depends  so  much  upon  the  Tiow  the  application  is  made,  as  in  obstetrical 
science ;  where,  for  the  most  part,  the  consequences  are  irreparable,  and 
even  the  "detail -consequences,"  as  evidences  of  irremediable  injury, 
proceed  as  much  from  the  sins  of  commission  as  of  omission. 


Selected  Articles^  Abstracts^  dbc.  IG"? 


Abstracts  ard  Seleciions  from  late  Medical  Journals. 


Prepared  for  the  Peninsular  and  Independent  Medical  Journal, 
By  M.  A.  Patterson,  M.  D.,  Tecumseh. 


DIPHTHERIA. 

In  England,  Diphtheria  has  become  a  common  household  word  of  fear- 
ful import.  It  is  the  name  of  a  disease  which  has  prevailed  within  that 
kingdom  during  the  last  two  or  three  years  with  great  severity,  affect- 
ing children  mostly,  though  in  some  localities  it  has  swept  away  whole 
families. 

In  addition  to  former  lengthy  descriptions  of  this  epidemic,  spread 
through  the  European  Medical  Periodicals,  we  have  before  us  thirteen 
of  the  large  pages  of  the  last  London  Lancet,  devoted  to  the  considera- 
tion of  this  "mysterious  malady." 

From  these  voluminous  details  we  learn  that  our  trans-x\tlantic 
brethren  have  expressed  very  different  views  respecting  its  nature  and 
origin.  The  vexed  questions  appear  to  be — Whether  the  disease  is  of 
domestic  origin,  or  an  importation  from  France  of  the  veritable  "diph- 
therite,"  originally  described  by  Bretonneau;  whether  it  is  allied  to  the 
epidemic  croupy  throat  affections  which  at  different  times  have  appeared 
in  widely  separated  districts  of  the  American  continent,  or  an  anomalous 
malignant  variety  of  common  sore  throat,  croup,  scarlatina  or  erysipelas, 
homonymous  in  form,  from  interchange  of  types ;  whether  it  is  of  para- 
sitic origin,  the  produce  of  the  fungus  ovidum  albicans,  as  gravely  an- 
nounced by  Prof  Laycock,  or  whether  the  parasitical  adherents  noticed 
by  the  learned  Professor  and  others  were  incidentally  attached  as  the 
disease  progressed,  and  not  the  originators  of  the  mischief;  whether  it 
is  contagious  or  non-contagious;  and,  lastly,  whether  this  is  the  first 
time  the  epidemic  has  visited  England,  or  whether  it  is  not,  in  reality, 
a  disease  described  Ijy  some  of  the  old  writers  as  prevalent  in  Britain 
years  ago,  again  revived  and  slightly  modified  by  existing  atmospheric 
influences. 

As  near  as  we  can  learn  from  the  documents  referred  to,  these^ 
questions  are  not  fully  settled.  The  weight  of  testimony,  however,  is 
decidedly  opposed  to  the  ovidium  albicans  theory  ;  and  the  most  reliable 
authorities  agree  that  the  English  "diphtheria"  and  the  continental  or 
French  "diphtherite"  are  essentially  similar;  and  from  the  brief  des- 
criptions of  peculiar  epidemic  throat  affections  given  by  some  of  our  old 
physicians,  commencing  with  the  epidemic  of  1771,  described  by  Dr. 
Bard,  together  with  the  recent  testimony  of  Dr.  Campbell,  the  intelli- 
gent Editor  of  the  Georgia  Southern  Medical  and,  Surgical  Journal,  there 
are  good  grounds  for  concluding  that  similar  epidemics  have  been  observed 
from  a  somewhat  remote  period,    in  the   United  States.      Should  thia 


108  The  Peninsular  and  Independent. 

conclusion  be  sustained  by  the  Profession  of  our  country,  it  will 
strengthen  the  apprehensions  already  expressed,  that  this  dangerous 
malady  may  again — perhaps  soon — invade  our  land  and  visit  our  own 
households.  In  this  view,  the  subject  assumes  an  aspect  of  importance 
beyond  its  mere  connection  with  the  literature  of  our  science.  There 
is  a  striking  uniformity  in  the  symptoms  of  the  disease,  as  described 
by  the  French  and  English  writers,  and,  according  to  Dr.  Campbell, 
the  cases  observed  by  him  in  Georgia,  in  1848,  presented  the  same 
peculiar  and  unmistakable  features.  Dr.  R.  J.  Foukgueaud  accurately 
describes  this  disease  in  the  Pacific  Medical  and  Surgical  Journal^  as 
it  prevailed  in  ihe  valley  of  Sonora,  California,  in  1856;  and  Dr.  Wil- 
LAKD,  in  the  Medical  and  Surgical  Reporter^  states  that  cases  of  true 
diphtherite,  of  a  most  fatal  character,  have  recently  been  noticed  in 
Albany,  New  York. 

Diphtheria  expends  its  force  upon  the  fauces  and  upper  respiratory 
tract,  producing  what,  in  intelligible  English,  is  called  "membranous 
sore  throat."  In  dangerous  cases  the  rapidity  with  which  false  mem- 
brane is  secreted,  and  spread  on  the  lips,  fauces,  and  upper  respiratory 
tract,  as  far  even  as  the  large  bronchial  tubes,  distinguishes  the  disease 
from  all  other  maladies.  It  may  prevail  in  a  sporadic,  endemic,  or  in 
a  wide -spread  epidemic  form;  but,  unlike  croup,  in  either  case,  the 
earliest  local  symptoms  and  first  deposit  of  false  membrane  appears 
above  the  windpipe.      Speaking  of  the  symptoms,  Dr.  Rankin  says : 

"  Sometimes  the  tonsils,  soft  palate,  and  uvula  are  seen  to  be  simply 
red:  and,  on  a  casual  view,  nothing  more  would  be  noticed.  But  even  in 
a  few  hours  after  the  first  feeling  of  uneasiness  a  more  careful  examination 
will  disclose  one  or  more  white  patches  on  the  tonsil,  not  larger,  perhaps, 
than  a  split  pea,  but  enough  to  warn  any  one  who  has  previously  seen  the 
disease  that  he  has  to  arm  himself  for  a  conHict  which  the  inexpeiienced 
would  scarcely  anticipate.  This  apparently  insignificant  patch  (oi-  patches) 
is,  in  fact,  the  diagnostic  sign  of  the  disease,  and,  unless  checked  speedily 
by  appropiiate  treatment,  is  destined  to  spread  over  the  whole  soft  palate, 
and  too  often  to  invade,  with  fatal  effect,  the  trachea  and  larger  bronchial 
tubes. 

'*In  a  certain  proportion  of  cases  we  are  warned  by  increased  difiBculty 
of  breathing,  attended  with  a  peculiar  croupy  sound^  that  the  diphtheritic 
me7nhr'ane  has  spread  to  the  larynx  and  trachea,  producing  a  state  of  things 
which  may  be  regarded  as  almost  inevitably  fatal." 

We  have  no  space  for  descriptions  of  the  treatment  pursued  by  the 
foreign  physicians,  and  can  only  add,  that  Dr.  Campbell  found  the  local 
application  of  powdered  alum  and  internal  use  of  quinine  "almost  spe- 
cific", in  his  cases  of  "  diphtheritis." 


Selected  Articles^  Abstracts,  dc.  io& 


"ON   THE    MANAGEMENT    OF  THE  SHOULDERS   IN  EXAMINATIONS    OF 
THE    CHEST." 

Dp.  John  W.  Couson,  late  Physician  to  Brooklyn  City  Plospita),  &c.,  has 
published,  in  the  JST.  Y.  Journal  of  Medicine,  ViYsdusihle  article  on  the  above 
subject.  His  rules  appear  to  us  of  much  importance,  especially  as  aids  for 
detecting  the  incipient  signs  of  consumption. 

In  the  ordinary  modes  of  exploration^  the  sounds  at  tops  of  the  lunga 
are  so  frequently  muffled  as  to  greatly  embarrass  our  diagnosis.  Any  ra- 
tional measures,  therefore,  proposed  to  assist  us  in  discovering  early  phy- 
sical signs  of  this  insidous  disease  are  entitled  to  consideration. 

The  proper  management  of  the  shoulders  can  not  be  mistaken  by  at- 
tention to  the  following  Summary : 

1.  That  remembering  the  great  value  of  many  reputed  "little  things," 
in  the  science  of  saving  life ;  and  that  the  chests  of  lean  persons  give 
clearest  sounds,  and  are  best  marked — we  may  seize  this  hint  fiom  nature, 
and  increase  the  "physical  signs,"  by  either  lessening  or  removing  more 
especially  those  principal  natural  obstacles,  the  great  pectorals  in  front,  and 
the  two  scapulae  and  their  muscles  behind. 

2.  This  may  be  effected  by  using  the  arms  as  levers,  and  the  hands  as: 
hooks  to  pull.  The  process,  in  each  case,  involves  three  principles — thin^ 
ninff,  condensing,  and  tightening.  It  is  illustrated  by  the  simple  experi.- 
ment  of  placing  one  forearm  of  a  muscular  man  behind  his  back,  while 
the  other  hangs  loosely  by  his  side,  when  the  sound,  especially  of  percus- 
Fion,  will  be  found  heightened  below  the  clavicle  of  the  stretched  side  in 
front. 

3.  That  the  suggestions  here  offered  are  not  fanciful  theories,  but  the 
results  of  practical  observations  on  several  hundred  patients  in  private, 
and  in  two  large  Dispensaries,  during  the  past  year.  The  drawings,  too 
were  copied  from  nature.  To  throw  back  the  shoulders  and  bare  ihewholo 
front,  we  need  the  ^^ first  position^  It  is  a  repetition  of  the  above  expe- 
riment with  hothvLvm^.  The  left  wrist  is  simply  held  easily  with  the  right 
hand  behind  the  loins.  This  has  many  little  advantages  in  obscure  cases. 
It  gives  symmetry,  gets  rid  of  the  arms,  and  fits  the  coat  of  flesh  closely, 
like  a  bandage,  for  "  inspection,"  makes  it  tense  to  increase  the  resonance 
of  delicate  percussion,  and  conducts  better  the  sounds  within.  It  thus  aids 
in  distinguishing  the  more  difficult  cases  of  tubercles,  pleurisy,  pneumonia, 
or  aneurism. 

4.  That  the  ^'second  position''^  is  the  common  one  of  locking  the 
hands  over  the  head  to  examine  the  axillae,  and  is  mentioned  to  avoid 
omission.  The  ^' third  position*^  crosses  the  arms  at  the  back  of  the  head, 
with  the  hands  grasping  near  the  elbows,  so  as  to  hoist  the  shoulder  blades 
high  up  behind,  and  thin  the  muscles,  to  search  for  obscure  or  limited 
pleurisy  or  pneumonia  low  down  near  the  diaphragm  posteriorly. 

5.  It  is  very  important  early,  in  suspicious  cases  of  cough,  to  examine 
carefully  the  tops  of  the  Ivngs  behind.  For  without  any  distinct  signs  in 
front,  consumption,  often  thus  mistaken  for  a  mere  throat  affection,  begins 
here.  A  few  scattered  tubercles  are  apt  to  hurrow,  as  it  were,  beneath  the 
top  of  the  shoulder.  Here  we  need  the  '''fourth  position.''''  For  this  the  pa- 
tient crosses  arms  in  front,  slightly  stooping,  hoohs  the  handsat  the  loins,or 
false  ribs,  and  then  stretching  upward  he  holds  fast  to  increase  the  tension. 
The  physician  aids  from  behind,  by  pressing  down  firmly  the  shoulders. 


110  The  Peninsular  and  Independent. 

They  are  thus  did  ojf,  the  muscles  are  smoothed  dou'n,  and  the  ear,  com- 
ing closer  upon  the  top  of  the  lung,  hears  better  the  sounds. 

6.  As  worth  more  than  all  the  rest,  we  commend  the  ^'Jifth  'position^'* 
for  by  natural  machinery  it  wrenches  the  shoulders  forward  out  of  their 
heds^  and  widely  severs  them  in  the  rear.  In  thin  persons  it  often  thus 
stretches  out  their  intervening  muscles  till,  like  stout  broadcloth,  it  thus 
quite  uncovers  the  inner  and  upper  part  of  the  lungs  behind.  To  accom- 
plish this  the  patient  crosses  arms  in  front,  with  the  stronger  outside, 
grasps  with  the  opposite  hands  the  two  shoulder  joints,  pulls  both  strongly, 
and  holds  fast  to  keep  them  tense.  The  ph3^sician  aids  to  fix  the  shoulder 
blades  widely  apartat  the  back  by  firmly  pushing.  Even  in  health,  as  any 
one  can  prove,  the  soft  breathing  murmur  attheformer  place  of  the  scapula 
can  be  thus  nearly  doubled.  In  tubercles  it  here  opens  a  new  field  for  j^a^ 
^aiz6>?i,  and  especially  {or  percussion.  It  intensifies  harsh  respiration,  or 
"  fatty  crackling."  In  pneumonia,  it  exaggerates  the  clear,  barrel-like 
echo  of  ''  bronchophony,"  and  in  pleurisy  that  line  between  wind  and  wa- 
ter, the  trembling  "  egophony."  It  brings  out  a  delicate  7?6?c  sign,  we  have 
discovered,  in  bronchitis.  It  is  a  kind  of  prolonged  liquid  breathing,  as  if 
through  a  layer  of  wet  sponge,  heard  before  or  after  mucous  rales,  which 
we  venture  to  name  moist  respiration. 

7.  Another  new  and  really  useful  "  physical  sign  "  we  have  to  commu- 
nicate, is  the  comparative  stiffness  of  the  shoulder  over  the  lung  most  dis- 
eased, in  strong  breathing,  seen  and  felt  from  behind.  For  this  we  may  use 
the  ^^  sixth  position.'*''  Facing  the  back  of  patient,  a  yard  distant,  near  a 
window  or  white  wall,  you  tell  him  to  drop  his  arras,  let  them  hang  easily 
by  the  sides,  "as  if  dead,"  and  then  breathe  deeply  for  a  few  moments, 
"like  a  man  a  little  out  of  breath."  You  then  *^'take  aim,"  like  a  rifleman, 
across  the  tops  of  the  shoulders,  and  then  shut  your  eyes  and  feel  them 
gently  swell.  Drawing  nearer  you  notice  that  the  "  inferior  angles"  of  the 
scapulae  move  gently  in  breathing  like  the  fins  of  a  fish.  You  can  both  see 
2kX\i\feel  this  movement.  The  stiffness  of  the  shoulder  in  breathing  may  be 
decided,  or  slight,  local,  or  general.  When  most  at  the  top,  we  term  it,  for 
convenience,  "  acomial,"  and  when  most  at  the  lower  extremity,  or  inferior 
angle,  we  call  it  "angular."  Curiously  enough,  these  last  features  seem 
to  depend  on  the  higher  or  lower  location  of  the  disease  which  thus,  as  it 
were,  paralyzes  theparfs  nearest.  An  elegant  way  of  testing  "angular  stiff- 
ness," even  in  a  lady  fully  clad,  is  to  place  your  two  index  fingers  on  the 
lower  points  of  her  shoulder  blades,  and  watch  and  feel  their  movement  as 
she  sighs.  The  causes  of  this  stiffness  are  supposed  to  be  loss  of  upward 
expansion  in  the  lung,  tenderness,  pleuritic  adhesions,  and  weight  of  morbid 
deposits.  A  table  of  eighteen  cases  is  added,  illustrative  of  this  sign.  It 
was  least  in  recent  attacks ;  varied  most  in  phthisis ;  was  slightest  in  pneu- 
monia, and  greatest  in  chronic  pleurisy. 

8.  A  statement  of  measurements  of  ten  males,  shows  the  gain  in  inches 
and  decimals,  by  "third,"  "fourth,"  or  "fifth,"  positions  respectively, 
between  the  inferior  angles  of  the  scapula  and  the  lowest  lumbar  vertebra : 
the  "  superior  angles  "  and  the  vertebra  prominens  of  the  neck  and  between 
the  two  upper  and  the  two  lower  angles  of  the  scapula.  Of  the  whole  of 
the  six  positions,  the  first,  ionvth,  fifth,  and  sixth  are  the  most  frequently 
useful.  The  others  apply  to  particular  cases.  Taking  into  account  the 
pulmonary  complications  of  other  diseases  as  well  as  the  range  of  "  chest 
disease,"  it  is  believed  these  various  improvements,  slight  as  they  seem  in 
detail,  really  throw  light,  perhaps,   upon  many  forms  of  one-third  of  the 

fatal  maladies  of  the  race. 

9.  On  account  of  its  fearful  importance,  it  is  hoped  they  will  mainly 


Selected  Articles^  Abstracts^  cbc.  111 

benefit  tubercular  consumption.  Tracing,  faitbfally  by  various  "  marks," 
and  the  unhealthy  habits  of  the  patient,  the  agencies  leading  to  the  two 
prevailing  causes, y^eS/e  organization  2iX\di  depraved  nutrition — by  prompt 
reform  of  abuses,  generous  animal food^  and  free  exercise  in  the  open  air^ 
with  tonics  and  cod-liver  oil — we  may  do  much  to  arrest  the  disease.  Oc- 
casionally we  maij  cure.  The  encouraging  researches  of  Hughes  Bennett, 
and  Messrs.  Rogee  and  Boudet  show  that  from  the  numerous  chalky  con- 
cretions, puckerings,  and  cicatrices  found  at  the  tops  of  the  lungs  in  very 
aged  persons,  it  is  probable  that  about  one-half  have  recovered  from  more  or 
less  tubercular  deposits  during  their  lives.  Four  living  cases,  from  several 
others,  are  reported  by  the  writer,  of  arrest  or  cure  of  phthisis  of  several, 
years'  standing.  The  great  question  of  this  paper  then  is,  What  may  he 
the  result  of  average  notice^  say  thre4  months  sooner  J  Time  only  can  tell. 
Each  physician  who  reads  this  is  earnestly  requested  to  aid  by  a  faithful 
trial  of  this  system  of  examinations  in  at  least  three  suitable  cases.  The 
malady  is  still  widely  and  deplorably  fatal.  From  extensive  trial,  we  firmly 
believe  that,  simple  as  they  may  seem,  this  management  of  the  shoulders^ 
these  expedients  for  thinning^  condensing.,  and  tightening  the  fleshy  walls  of 
the  chesty  add  fully  one-third  to  our  power  of  detecting  the  earliest  signs  of 
consumption. 


ORTORRHCEA  AND  ARTIFICIAL  TYMPANUMS. 

In  the  April  No.  of  the  American  Medical  Monthly,  we  notice  some 
judicious  remarks  on  these  subjects,  by  Dr.  J.  Henry  Clark. 

Muco- purulent  discharges  from  the  ears  may  be  generally  and  sea- 
sonably arrested  by  proper  early  treatment,  and  the  prospect  of  a  life -long, 
loathsome  disease,  with  partial  or  total  deafness,  prevented.  The  following 
remarks  are  sensible,  and  to  the  point : 

*'  If  the  ear  received  the  same  watchful  attention  during  an  attack  of 
scarlatina,  and  subsequently,  a  smaller  number  of  children  would  be  per- 
manently deaf;  and  if  the  cases  were  followed  up  by  the  treatment  of  the 
anaemic  condition  that  frequently  ensues,  fewer  tympanums  would  be  de- 
sti'oyed.  The  worst  cases  of  scarlatina  occur  in  scrofulous  subjects,  in 
which  measures  termed  anti- phlogistic  would  be  inadmissible.  The 
prompt  administration  of  tonics  and  anti  -  scrofulous  remedies,  with  due 
regard  to  the  condition  of  the  bowels,  with  counter  -  irritation  behind  the 
ears,  will  generally  prevent  mischief. 

"  Some  physicians  discourage  the  treatment  of  the  discharge  after  re- 
covery from  the  eruptive  disease  of  childhood,  and  in  this  way  induce  fatal 
neglect.  Parents  are  told  that  'the  child  will  outgrow  it,'  that  it  will  get 
no  worse,  that  it  is  dangerous  to  arrest  the  discharge,  and  are  sometimes 
advised  to  stuff  the  meatus  with  cotton,  and  wait  for  time  and  improved 
health  to  do  the  rest.  The  truth  is,  these  cases  do  seldom  improve  without 
interference.  It  is  just  as  safe  to  arrest  a  discharge  in  this  situation  as  in 
any  other.  It  is  dangerous,  highly  so,  not  to  do  it  just  as  soon  as  it  can  be 
pone  in  a  proper,  legitimate  manner.  It  is  dangerous  to  life,  as  well  as  to  the 
faculty  of  hearing,  to  permit  the  discharge  to  continue,  while  it  is  to  the 
highest  degree  unpleasant  and  mortifying  to  a  sensitive  patient.  If  the 
discharge  must  continue,  it  is  better,  far  better,  not  to  put  cotton  in  the 
ear.  That  hole  was  never  designed  to  be  stuffed.  Cases  could  be  cited 
which  have  recently  come  under  our  own  observation,  in  which  a  cure  was 


112  The  Peninsular  and  Independent. 

effocterl  by  simply  removing  the  cotton  and  ordering  a  discontinuance.  *  ^ 
With  regard  to  the  treatment  of  these  cases,  imlcss  produc*  d  by  morbid 
growths,  we  rely  upon  astringents  and  alternatives  locally  applied,  with 
constitutional  treatment  if  required.  It  is  frequently  a  mere  local  disease. 
"  In  a  majority  of  cases  of  ortonha^a  occurring  in  adults,  the  tym- 
panum is  ruptured  or  paitially  obliterated.  AVlien  the  disease  is  fully  ar- 
rested, the  discharge  wholly  ceases,  and  the  surface  that  has  secreted  a 
muco- purulent  fluid,  fuinishes  wax.  After  the  first  stage  of  cure  is  pass- 
ed— during  which  the  hearing  is  impaired,  rather  than  improved,  because 
the  fluid  aflbidcd  a  medium  for  the  transmission  of  sound  to  the  internal 
ear — the  artificial  tympanum  may  be  used  often  with  manifest  advantage." 

By  way  of  encouraging  those  who  may  have  cases  of  this  nature  un- 
der their  chaige,  in  the  persevering  use  of  local,  and,  when  indicated,  con- 
stitutional tieatment,  we  add  the  following: 

"  On  referring  to  our  record,  which  includes  patients  of  nearly  every 
agD,  from  a  few  months  to  full  maturity,  we  conclude  that  if  the  patient  is 
under  ten  5'cars  of  age,  six  months  may  be  named  as  tlie  possible  limit  of 
the  continuance  of  the  disease.  It  is  oftener  cured  in  less  time.  If  the 
patient  is  under  fifteen,  nine  months  may  be  named,  with  the  expectation 
of  effecting  a  cure  in  less  time.  If  over  fifteen,  one  year  is  the  lea>t  period 
of  time  that  it  is  safe  to  calculate  upon,  and  if  older,  it  may  require  years; 
but  if  patience  does  not  fail,  a  cure  may  be  promised  as  likely  to  result. 
As  is  true  of  all  diseases,  some  cases,  in  the  present  state  of  our  knowl- 
edge, are  incurable,  but  they  are  believed  to  be  very  rare." 

After  alluding  to  Yearsley's  moistened  cotton  plug,  and  Toynbee's 
splierical  rubber  drum,  Dr.  Clakk  recommends,  as  generally  preferable  to 
these,  an  egg-shaped  or  elliptical  artificial  tympanum  of  his  own  invention, 
which  may  be  procured  of  Mr.  Tiemann,  Chatham  street,  N.  Y.  A  perfect 
artificial  tympanum,  however,  is  still  a  desideratum,  and  the  following 
closing  remarks  call  upon  Yankee  ingenuity  to  tax  its  best  powers  for 
the  relief  of  the  afflicted : 

*'  It  would  seem  as  if  the  bladder  of  some  animal,  or  some  otHer 
unexamined  material,  would  furnish  the  article  required  for  the  best 
artificial  tympanum.  If  we  can  succeed  in  stimulating  to  more  diligent 
inquiry  in  this  direction,  our  whole  object  will  be  accomplished.  We 
should"  be  glad  to  see  a  better  drum  than  the  one  that  we  introduce. 
In  the  meanwhile,  we  would  beg  for  it  a  fair  trial." 


PURULENT  OPTHALMIA. 

M.  DeConde,  a  Surgeon  in  the  Belgian  army,  recommends  the  in- 
troduction of  a  thin  slip  of  wadding  beneath  the  upper  eye  Ijds  to  pre- 
vent the  heated,  rough,  and  pus  flooded  surlace  of  the  lids  from  direct 
contact  with  the  eyes.  He  regards  this  immediate  contact  of  the  lids, 
covered  as  they  generally  are  with  acrid  pus,  a  main  cause  of  the  exces- 
sive irritation  and  frequent  disorganization  of  the  cornea.  The  slip  of 
wadding  may  be  medicated  before  its  introduction  with  one  of  the  follow- 
ing articles,  the  therapeutic  effects  of  which  are  thus  explained : 


Twelfth  A7inual  Meeting  of  Am.  Med.  Association.     113 

1.  Cod -liver  oil  exercises  a  powerful  action  in  diseases  of  the  mucous 
membranes,  modifying  and  suppressing  their  secretions.  It  strengthens 
the  fibrous  tissues  of  the  eye  and  the  cornea,  and  tends  to  prevent  ramol- 
lissement.  It  is  especially  in  ulceration  and  chronic  ramollissement  of 
this  membrane  that  this  double  action  is  perceived. 

2.  The  red  precipitate  ointment  (four  parts  to  fifteen  of  lard  and  fifteen 
of  linseed  oil),  is  an  excellent  substitutive  agent,  sufficing  alone  to  arrest 
the  disease,  when  applied  earlj^.  It  is  the  best  remedy  for  cutting  short 
the  opthalmia  of  new-born  infants. 

3.  A  solution  of  chloride  of  lime  (thirty  parts  to  two  hundred  of 
water),  is  an  energetic  modifier,  neutralizing  with  certainty,  the  virulence 
of  the  secretions. 

4.  Perchloride  of  iron  exerts  an  instantaneous  hoemostatic  effect  upon 
the  ha3morrhagic  mucous  membrane,  and  an  indubitable  modifying  influ- 
ence upon  the  mucous  secretion. 

[Atumls  (V  Oculist  [que— Trans,  for  Br.  ^'  Foreign  Med.  df  Chir.  Revieio. 


THE   TWELFTH   AXXIAL    MEETING    OF   THE   AMERICAJf   MEDICAL 

ASSOCIATION. 


Louisville,  May  3,  1859. 
The  Association  met  at  eleven  o'clock  A.  M.  in  Mozart  Hall,  the  Presi- 
dent, Dr.  Harvey  Lindsley,  of  the  District  of  Columbia  in  the  chair, 
supported  by  Drs.  AV.  L.  Sutton,  of  Kentuck}',  Thomas  0.  Edward  of  Iowa, 
Josiah  Crosby,  of  Massachusetts,  and  W.  C.  Warren,  of  North  Carolina, 
as  Vice-Presidents,  with  Drs.  Alexander  J.  vSemmes,  of  the  District  of  Co- 
lumbia, and  S.  M.  Bemiss,  of  Kentucky,  acting  as  Secretaries.  Dr.  Caspar 
Wistar,  of  Penn.,  Treasurer,  was  also  in  attendance. 

The  President  announced  the  Rev.  Mr.  Robinson,  of  Louisville,  who 
opened  the  proceedings  with  prayer. 

Dr.  Robert  J.  Breckinridge,  chairman  of  the  committee  of  arrange- 
ments, then  welcomed  the  delegates  to  the  city. 

Prof.  Joshua  B.  Flint  of  Louisville,  accompanied  by  Drs.  Sutton, 
Chiplej',  Spillman,  and  Snead,  then  came  forward  and  addressed  the  Presi- 
dent as  follows : 

Mr.  President :  At  a  late  annual  meeting  of  the  "  State  Medical  Society 
of  Kentucky,"  the  following  resolution  was  unanimously  adopted,  and  the 
gentlemen  before  you,  all  of  them  ex  -  Presidents  of  the  Society,  constituted 
a  committee  charged  with  carrying  it  into  effect : 

Resolved,    That be  a  committee  to  wait  upon  the  A.  M.  Association,  so 

soon  as  it  shall  have  opened  its  session  in  Louisville,  and  in  behalf  of  this  Society  bid  it 
welcome  to  the  medical  jurisdiction  of  Kentucky,  assure  it  of  the  cordial  interest  of  the 
profession  of  the  State  in  the  objects  and  purposes  of  its  institution,  and  of  the  readiness 
of  this  Society  to  co-operate  in  all  its  endeavors  to  promote  the  honor  and  usefulness  of 
our  common  calling. 

Vol.  II.  — H. 


114  The  Peninsular  and  Independent. 

In  regard  to  assurances  of  welcome,  Mr.  President,  so  far  as  they  ap- 
ply to  yourself  and  your  associates,  as  individual  guests  of  your  Kentucky 
brethren,  those  gentlemen  would  hardly  pardon  me  for  adding  a  word  to 
the  general  terms  of  the  resolution.  Already,  if  I  mistake  not,  there  are 
demonstrations  of  the  spirit  of  hospitality,  which  render  any  assurances 
on  that  subject  worse  than  superfluous. 

But  I  am  happy  to  assure  you,  Mr.  President,  that  the  Association 
over  which  you  preside,  in  its  corporate  capacity,  with  its  well  known  pur- 
poses and  ends,  will  find  an  equally  cordial  reception  in  the  general  com- 
munity which  it  has  now  honored  with  its  presence.  The  people  of  Ken- 
tucky, Sir,  are  generally  supposed  to  appreciate  as  it  deserves  every  enter- 
prise of  a  public  spirited  or  philanthrophic  character  which  presents  itself 
to  their  notice,  and  I  think  I  may  say  especially  disposed  to  befriend  the 
cause  of  Medical  Education.  They  have  certainly  done  somewhat  a  little 
to  their  credit  in  evidence  of  their  intelligent  interest  in  Medical  vScience 
and  the  best  means  of  its  advancement.  Through  the  munificence  of  the 
State,  in  one  case,  and  of  this  liberal  city  in  the  other,  two  medical  libra- 
ries have  been  procured  in  Kentucky,  each  of  which  is  superior  to  any 
and  all  the  public  collections  of  medical  books  that  can  be  found  in  most 
of  the  other  States  of  the  Union.  Not  more  than  two  of  our  sister  States, 
so  far  as  I  can  learn,  can  be  compared  with  us  in  this  interesting  par- 
ticular. 

One  of  those  Libraries,  belonging  to  the  Medical  Department  of  the 
University  of  Louisville,  as  its  best  estate,  numbering  4,000  volumes,  you 
will  doubtless  visit  during  your  sojourn  among  us ;  and,  although  much 
defaced  and  mutilated  by  the  conflagration  which  laid  that  institution  in 
ruins  two  years  ago,  you  will  still  find  it  to  be  a  large  and  choice  collection 
—  adequate  to  the  requisitions  of  medical  research,  and  presenting  satis- 
factorily the  course  of  medical  literature  from  the  time  of  Hippocrates  to 
the  present  day. 

The  other  library  to  which  I  refer  belongs  to  the  Medical  Department 
of  Transylvania  Univcrsit)^  and  contains  b,000  volumes.  I  hope  that 
not  a  few  of  the  members  of  the  Association  before  leaving  Kentucky  will 
find  their  way  into  that  also,  in  the  course  of  a  visit  to  the  beautiful  inland 
city  in  which  it  is  located  —  a  city  distinguished  throughout  the  land  for 
the  general  intelligence  and  refinement  of  its  population,  as  well  as  for  the 
eminent  public  men  who  have  signalized  it  as  their  home ;  but  to  medical 
men,  not  only  of  our  own,  but  of  foreign  countries,  especially  memorable  as 
the  residence  of  the  great  lithotomist  of  our  day  and  surgical  patriarch  of 
the  West — Benjamin  W.  Dudle}^ 

Such  benefactions  as  these  to  the  means  of  medical  study,  attest,  as 
I  have  already  intimated,  so  enlightened  an  interest  in  the  improvement 
of  our  Profession  as  to  guarantee  not  only  a  welcome  to  the  Association 
which  represents  it,  but  efficient  co-operation  in  its  endeavors  on  the  part 
of  the  Profession  and  people  of  Kentucky. 

May  your  present  session,  Mr.  President,  be  an  agreeable  one  to  the 
members  of  the  Association,  and  prove  eminently  beneficial  to  the  interests 
of  American  medicine. 

The  Secretary,  Dr.  Bemiss,  then  called  the  roll  of  the  members  of 
the  Association,  and  two  hundred  and  forty  gentlemen  were  in  attend- 
ance. 

The  President  then  appointed  the  following  gentlemen  a  committee 
on  voluntary  essays :  Drs.  L.  P.  Yandell  of  Kentucky,  Bryan  of  Philadel- 
phia, and  Comegys  of  Ohio. 

Dr.  R.  J.  Breckmrdge,  fi'om  the  Committee  of  Arrangements,  an- 
nounced the  hours  of  business  from  9  a.m.  to  12  m.,  and  from  3  p.  m.  until 


Twelfth  Annual  Meeting  of  Am.  Med.  Association.     115 

such  hour  as  the  Convention  should  adjourn  upon  resolution,  which  arrange- 
ment was  adopted. 

Dr.  Harvey  Lindsley,  the  President  of  the  Association,  then  read  his 
retiring  Address,  which  was  listened  to  with  marked  attention,  and  was 
an  eloquent  tribute  to  the  dignity  of  the  medical  profession  and  the  im- 
portance of  its  improvements. 

After  he  had  concluded.  Dr.  Landon  A.  Smith  of  New  Jersey,  moved, 
that  the  thanks  of  the  Association  be  tendered  to  the  President  for  his 
able  and  eloquent  address,  and  it  was  ordered  to  be  placed  in  the  hands 
of  the  appropriate  committee,  for  publication  among  the  proceedings  of  the 
meeting. 

Dr.  Caspar  Wistar,  chairman  of  the  Committee  on  Publication,  read 
the  Annual  Report ;  and,  on  motion  of  Dr.  Sayers,  of  New  York,  the  follow- 
ing resolutions,  appended  to  it,  were  unanimously  adopted : 

Resolved,  That  hereafter  every  paper  intended  for  publication  in  the  Transactions 
must  not  only  be  placed  in  the  hands  of  the  Committee  of  Publication  by  the  1st  June, 
but  it  must  also  be  so  prepared  as  to  require  no  material  alteration  or  addition  at  the 
hands  of  the  author. 

Resolved,  That  authors  of  papers  be  required  to  return  their  proofs  within  two 
weeks  after  their  reception,  otherwise  they  will  be  passed  over  and  omitted  from  the 
volume. 

Adjourned  until  3  o'clock  p.m. 

Afternoon  Session. 

Dr.  W.  L.  Sutton,  one  of  the  Vice  -  Presidents,  took  the  chair  in  the 
absence  of  the  President. 

Dr.  D.  Meredith  Reese,  of  New  York,  chairman  of  the  Committee 
on  Nominations,  reported  the  following  officers  for  the  ensuing  year: 

President — Henry  Miller,  of  Kentucky. 

Vice  -  Presidents  —  H.  F.  Askew,  Delaware  ;  Chas.  S.  Tripler,  U.  S.  Army ;  L.  A- 
Smith,  New  Jersey  ;  Calvin  West,  Indiana. 

Treasurer  —  Caspar  Wistar,  Pennsylvania. 
Secretary  —  S.  M.  Bemiss,  Kentucky. 

Dr.  Sayre,  moved  the  adoption  of  the  Report,  which  was  unanimously 
agreed  to. 

Dr.  Brainard,  of  Illinois,  moved  the  appointment  of  a  committee  to 
conduct  the  newly  appointed  officers  to  their  respective  chairs.  The 
acting -President  selected  Drs.  Brainard,  of  111.,  Mattingly,  of  Ky.,  Sutton, 
of  Ind.,  McDowell,  of  Mo.,  and  R.  J.  Breckinridge  of  Ky.,  and  they  ac- 
cordingly performed  the  duties  assigned  to  them. 

The  newly -elected  President,  on  taking  the  chair,  addressed  the  Con- 
vention  in  substance  as  follows : 

Gentlemen  of  the  American  Medical  Association:  I  am  wholly  at  a 
loss  to  command  language  to  express  the  deep  sense  of  obligation  put  upon 
me  by  calling  me  to  the  Presidency  of  your  Association.  It  is  an  honor 
any  man  may  well  be  proud  of,  and  although  I  admit,  in  all  sincerity, 
that  you  might  without  difficulty  have  selected  an  individual  more  worthy 
the  position,  I  may  be  allowed  to  say  you  could  not  have  conferred  it 
upon  one  who  would  prize  it  more  highly  or  cherish  it  longer  with  the 
most  grateful  recollection.  I  do  esteem  it  the  greatest  honor  ever  confer- 
red upon  me  by  the  Profession  that  I  love  and  to  which  I  have  devoted 
a  long  life ;  nay,  more  —  it  is  the  greatest  honor  that  could  be  conferred 
upon   any  man  by  the  medical  or  any  other  profession  in   this   or  any 


116  The  Peninsular  and  Independent, 

other  country ;  for  any  decoration  of  honor  or  any  mark  of  approbation 
conferred  by  a  crowned  head  I  should  regard  as  a  bauble  in  comparison. 
Who  are  you,  gentlemen,  when  rightly  considered  ?  You  are  the  rightful 
representatives  of  the  great  American  Medical  Profession  —  an  arm}-  forty 
thousand  strong,  and  a  body  of  men,  no  matter  what  captious  criticism 
may  say  in  disparaging  comparison  with  the  European  branch  of  the  pro- 
fession, in  my  humble  judgment,  far  superior  to  the  same  number  of 
medical  men  to  be  found  in  any  quarter  of  the  globe.  Although  as  a 
body  you  may  not  be  so  learned,  so  critically  and  nicely  framed  in  all 
the  minutiae  of  the  Profession,  yet,  for  strength,  integrity,  and  precision 
in  all  the  great  principles  guiding  to  a  successful  combat  with  disease, 
this  body  is  equal,  if  not  superior,  to  that  of  any  kingdom  of  continental 
Europe. 

To  be  called  to  the  Presidency  of  such  a  body  of  men,  is  in  my 
sober  judgment,  the  greatest  compliment  that  could  be  conferred  upon 
mortal  man,  provided  that  man  is  a  devotee  of  medicine,  who  has  given 
his  whole  mind,  soul,  heart,  and  strength  individually  to  the  Profes"<ion, 
and  has  that  high  rcgai'd  for  it  which  will  not  sutler  any  less  noble  pur- 
suit to  interfere  with  the  dail}'-  though  laborious  duties  of  the  Profession. 
Coming  so  recently  from  a  sick  bed,  and  still  enfeebled  in  health,  I  beg  to 
be  excused  from  further  remarks,  and  desire  3'ou  to  accept  this  brief  and 
imperfect  acknowledgment  of  the  distinguished  honor  conferred  upon  me, 
instead  of  what,  under  other  circumstances,  I  might  be  disposed  to  say. 

The  President,  after  this  gi^ceful  Address,  sat  down  amid  much  ap- 
plause; when  Dr.  R.  J.  Breckenridge  moved  that  the  thanks  of  the  As- 
sociation be  tendered  to  the  retiring  ofhcers  for  the  faithful  and  assidu- 
ous manner  in  which  they  have  conducted  the  business  committed  to 
their  charge ;  which  was  unanimously  adopted. 

A  long  and  discursive  debate  then  ensued  on  the  admission  of  mem- 
bers by  invitation.  The  plan  of  organization  permits  practitioners  of  re- 
spectable standing  from  sections  of  the  United  States,  not  otherwise  repre- 
sented at  the  meeting,  to  receive  appointment,  by  invitation,  of  the  meet- 
ing, after  an  introduction  from  any  of  the  members  present,  or  any  absent 
permanent  members,  to  hold  connection  with  the  Association  until  the  close 
of  the  annual  session  at  which  they  are  received,  and  to  be  entitled  to  par- 
ticipate in  all  its  affiiirs  as  in  the  case  of  delegates.  The  point  of  diffi- 
culty seemed  to  be  whether  the  invitations  should  be  extended  by  the 
Committee  of  Arrangements  or  by  open  vote  of  the  Association.  It  wa^ 
finally  settled  by  referring  all  the  applicants'  names  to  the  Committee  on 
Arrangements. 

Dr.  J.  B.  Lindsley,  of  Tennessee,  offered  the  following : 

Resolved,  That  a  committee  of  three  be  appointed  by  the  Chair  to  inquire  into 
and  report  upon  the  propriety  of  dividing  the  Association  into  sections,  for  the  pui-poso 
of  performing  such  parts  of  its  scientific  labors  as  may  relate  to  particular  branches  of 
•medicine  and  surgerJ^ 

Dr.  Brodie  moved  its  reference  to  the  Xominating  Committee. 

Dr.  Brainard  explained  at  some  length  the  object  of  the  resolution  of 
inqmry,  and  enforced  its  adoption  as  the  means  of  giving  more  effect 
and  usefulness  to  the  proceedings  of  the  Association,  the  reports  of  which 
had  heretofore  gone  out  unmatured,  in  consequence  of  the  want  of  con- 
centrated action. 

A  motion  by  Dr.  Sayre  to  lay  the  motion  on  the  table  was  negatived, 
and  the  motion  of  Dr.  Lindsley  was  then  adopted. 

Dr.  Davis  moved  that  no  person  be  permitted  to  speak  more  than 
twice  on  the  same  subject,  or  more  than  ten  minutes  at  one  time,  except 
by  consent  of  the  Association  ;  which  was  adopted. 


Twelfth  Annual  Meeting  of  Am.  Med.  Association.     117 

The  Standing  Committee  on  Prize  Essays  was  called  on  for  their 
Report,  but  without  a  response.  This  was  also  the  case  with  the  Com- 
mittee on  Medical  Education.  The  Committee  on  Medical  Literature  had 
no  Report  to  present. 

A  letter  from  Dr.  J.  G.  F.  Holston,  of  Ohio,  Chairman  of  the  Special 
Committee  on  the  Microscope,  was  read,  reporting  progress,  and  begging 
a  continuance  for  more  extended  investigation,  which  was  referred  to  the 
Committee  on  Nominations. 

A  letter  from  Dr.  Stephen  Smith,  of  New  York,  from  the  Special 
Committee  on  Medical  Jurisprudence,  had  the  same  reference. 

The  Special  Committee  on  Quarantine  was  not  ready  to  report. 

Dr.  Mattingly,  of  Ky.,  from  the  Special  Committee  on  Diseases  and 
Mortality  of  Boarding  Schools,  asked  a  continuance  until  next  year,  in 
order  to  obtain  further  information  requisite  to  the  full  investigation  of  the 
important  subject.  The  request  was  referred  to  the  Committee  on  Nomi- 
nations. 

The  Special  Committees  on  Surgical  Operations  for  the  relief  of  De- 
fective Vision,  on  Milk  Sickness,  and  on  the  Blood  Corpuscle  had  the  same 
reference. 

A  Report  from  the  Committee  on  Medical  Ethics,  signed  by  Dr.  John 
Watson,  of  New  York,  was  read,  laid  on  the  table,  and  made  the  special 
order  for  to-morrow,  at  12  o'clock  m.  This  is  an  important  subject,  and 
will  probably  give  rise  to  much  debate  to-day.  We  publish  the  Report  in 
full,  as  follows : 

To  the  American  Medical  Association: 

Tho  Committee  on  Medical  Ethics  beg  leave  to  state  that,  of  the  subjects  referred  to 
them  at  the  last  meeting  of  the  Association,  they  find  the  following  notice  in  the  minutes: 

"  Dr.  Grant,  of  New  Jersey,  presented  a  complaint  made  by  the  Newark  Medical 
Society  against  the  New  York  Medical  College,  for  a  violation  of  the  ethics  of  the  Profes- 
sion. Dr.  Edwards,  of  Iowa,  presented  a  similar  complaint,  and  Dr.  Oakley,  of  New 
Jersey,  a  complaint  from  the  Union  and  Essex  Coimty  Medical  Society." — [Transactions, 
Vol.XI.  p.  41.j 

Upon  these  several  complaints  your  Committtec  beg  leave  most  respectfully  to  re- 
port : 

That  the  two  complaints  from  the  Medical  Societies  of  New  Jersey  refer  only  to  one 
and  the  same  grievance,  the  particulars  of  which  are  set  forth  in  a  memorial  which  was 
presented  to  the  American  Medical  Association  on  the  6th  of  May,  1848,  and  which  is 
entitled,  "  Statement  of  the  Newark  Medical  Association  in  Keference  to  a  Diploma 
granted  by  the  New  York  Medical  College." 

The  facts  stated  in  this  memorial  which  is  now  appended  to  this  Report,  were,  during 
the  last  annual  meeting  of  the  American  Medical  Association,  examined  as  carefully  as 
time  and  opportunit}''  would  allow.  The  charges  therein  contained  against  the  New  York 
Medical  College  were  admitted  to  be  true  by  Dr.  Horace  Green,  President  of  said  college, 
who,  in  apology  for  the  same,  submitted  a  written  statement  to  your  Committee,  which 
was  at  the  time  accepted  as  satisfactory  by  the  gentlemen  then  present  before  your  Com-  > 
mittee  on  behalf  of  the  parties  aggrieved  ;  and  being  afterwards  presented  with  a  verbal 
report  by  the  Committee,  was  received  and  entered  upon  the  minutes  in  the  following 
terms  : 

"  Whereas,  it  appears  from  undoubted  testimony  that  the  New  York  Medical  Col- 
lege have  conferred  the  degree  of  Doctor  of  Medicine  upon  a  notorious  quack  of  the 
name  of  John  F.  Dunker,  of  Newark,  the  Faculty,  in  the  person  of  the  President  of 
said  College,  wish  here  to  declare,  that  the  degree  was  obtained  under  gross  deception 
and  false  testimonials  furnished  by  said  Dunker  and  his  friends:  and  they  therefore  re- 
voke and  annul  his  diploma,  and  declare  said  Dunker  to  be  unworthy  of  patronage  or 
Support  from  authority  conferred  upon  him  by  this  diploma." — [Transactions,  Vol.  XI. 

P-— ■] 

These  complaints  being  thus  disposed  of,  your  Committee  have  only  to  add  in  refer- 
ence to  them  that  the  memorial  presented  to  the  American  Medical  Association  from  the 
Newark  Medical  Association  is  worthy  of  special  notice,  as  setting  forth  the  negligent 
manner  in  which  mere  verbal  and  hearsay  statements  are  at  times  accepted  in  place  of 
authentic  written  testimonials,  from  individuals  presenting  themselves  as  candidates  for 
the  honors  of  our  Profession  at  some  of  the  Medical  Colleges  of  this  country.    In  this 


118  The  Peninsular  and  Independent. 

respect  there  is  reason  to  believe  that  the  New  York  Medical  College  does  not  stand  alone  .^ 
and  the  publication  of  the  accompanying  memorial  may  be  of  service  in  putting  a  per- 
manent check  to  this  crying  evil. 

The  only  other  complaint  referred  to  your  Committee  was  that  presented  by  Dr. 
Edwards,  of  Iowa,  preferring  a  charge  from  the  Dubuque  Medical  Society  against  one 
of  her  members  who  had  been  expelled  for  an  alleged  infraction  of  the  code  of  medical 
ethics.  This  complaint  does- not  appear  to  be  of  such  a  character  as  to  require  adjudica- 
tion here.  It  has,  since  the  last  annual  meeting  of  the  American  Medical  Association, 
been  adjudged  by  the  Iowa  State  Medical  Society  [see  Transactions  of  the  annual  meet- 
ing of  said  Society,  published  at  Dubuque,  Iowa,  1858],  and  having  been  then  settled  in 
the  State  in  which  the  parties  reside,  it  should  now  be  dismissed. 

All  of  which  is  respectfully  submitted. 

JOHN  WATSON,  M.D.,  Chairman. 

New  York,  April  28,  i859. 

Continuances  were  asked  by  the  Committees  on  the  Pons  Varolii, 
Medulla,  Oblongata,  and  Spinal  Marrow  —  their  Pathology  and  Therapeu- 
tics ;  on  American  Medical  Necrology ;  on  the  Hygienic  relations  of  Air, 
Food,  and  Water,  the  Natural  and  Artificial  Causes  of  their  Impurity,  and 
the  best  methods  by  which  they  can  be  made  most  effectually  to  contribute 
to  the  Public  Health ;  on  the  Effect  of  the  Virus  of  Rattlesnakes,  &c., 
when  introduced  into  the  system  of  the  Mammalia ;  on  the  Climate  of  the 
Pacific  Coast,  and  its  Modifying  Influences  upon  Inflammatory  Action  and 
Diseases  generally;  on  the  Constitutional  Origin  of  Local  Diseases,  and 
the  Local  Origin  of  Constitutional  Diseases ;  on  the  Physiological  Effects 
of  the  Hydro-Carbons ;  on  Epilepsy  ;  on  the  Causes  of  the  Impulse  of  the 
Heart,  and  the  Agencies  which  influence  it  in  Health  and  Disease  ;  and  on 
the  best  substitutes  for  Cinchona,  and  its  Preparations  in  the  Treatment  of 
Intermittent  Fever,  &c. ;  all  of  which  were  referred  to  the  Committee  on 
Nominations. 

The  Special  Committee  on  Government  Meteorological  Reports  made 
a  Report,  written  by  Dr.  R.  H.  Coolidge,  of  the  U.  S.  Army,  but  read  by 
Dr.  Paul  F.  Eve,  of  Tennesee,  which  was  referred  to  the  Committee  on 
Publication. 

The  Committee,  appointed  in  May,  1857,  on  Criminal  Abortion,  sub- 
mitted a  Report,  written  by  Dr.  Storer,  of  Boston,  which  was  read  by  Dr. 
Blatchford,  of  New  York,  and  referred  to  the  Committee  on  Publication. 
The  following  resolutions  appended  to  this  Report  were  unanimously 
adopted : 

Resolved,  That  while  physicians  have  long  been  united  in  condemning  the  act  of 
producing  abortion,  at  every  period  of  gestation,  except  as  necessary  for  preserving  the 
life  of  either  mother  or  child,  it  has  become  the  duty  of  this  Association,  in  view  of  the 
prevalence  and  increasing  frequency  of  the  crime,  publicly  to  enter  an  earnest  and  solemn 
protest  against  such  unwarrantable  destruction  of  human  life. 

Resolved,  That  in  pursuance  of  the  grand  and  noble  calling  we  profess  —  the  saving 
of  human  lives  —  and  of  the  sacred  responsibilities  thereby  devolving  upon  us,  the  Asso- 
ciation present  this  subject  to  the  attention  of  the  several  Legislative  Assemblies  of  the 
Union  with  the  prayer  that  the  laws  by  which  the  crime  of  procuring  abortion  is  attempted 
to  be  controlled  may  be  revised,  and  that  such  other  action  may  be  taken  in  the  premises 
as  they  in  their  wisdom  may  deem  necessary. 

Resolved,  That  the  Association  request  the  zealous  co-operation  of  the  various  State 
Medical  Societies  in  pressing  the  subject  upon  the  Legislatures  of  their  respective  States, 
and  that  the  President  and  Secretaries  of  the  Association  are  hereby  authorised  to  carry 
out  by  memorial  these  resolutions. 

The  Convention  then  adjourned  until  to-morrow  morning  at  9  o'clock. 

Second  Day's  PROCEEorN-GS. 

"Wednesday,  May  4,  1859. 
The  President,  Dr.  Miller,  called  the  Association  to  order  at  9  o'clock. 
Dr.  D.  Meredith  Reese,  chairman  of  the  Committee  on  Nominations, 
called  attention  to  the  fact  that  the  Committee  could  not  act  definitely 


Twelfth  Annual  Meeting  of  Am.  Med.  Association.     119 

until  the  place  for  next  year's  meeting  should  be  designated.  He  stated 
also  that  the  Medical  State  Society  of  Connecticut  had  requested  that  an 
amendment  to  the  Constitution,  proposed  two  years  since,  should  be  taken 
from  the  table,  relative  to  the  time  of  meeting. 

It  was  moved  by  Dr.  Blatchford,  and  seconded  by  Dr.  Sayre,  that 
the  amendment  to  the  third  article  of  the  Constitution  be  taken  up,  which 
proposes  to  add  after  the  words  " first  Tuesday  of  May"  the  words  "or 
first  Tuesday  of  June,"  and  after  the  words  "  shall  be  determined  "  add 
the  words  "with  the  time  of  meeting." 

The  amendment  was  adopted  by  a  constitutional  vote. 

Dr.  D.  M.  Reese  also  stated  that  the  Connecticut  State  Society  had 
extended  a  pressing  invitation  to  the  Association  to  hold  its  next  meeting 
at  New  Haven  ;  which  invitation  was  referred  to  the  Committee  on  Nomi- 
nations. 

Dr.  Reese  also  called  attention  to  the  necessity  of  some  radical  change 
in  the  mode  of  appointing  committees  to  prepare  treatises  on  scientific 
subjects  to  be  reported  at  the  annual  meetings.  It  had  been  seen,  that,  on 
yesterday,  a  large  majority  of  the  committees  made  no  reports,  and  did 
not  even  see  proper  to  send  in  any  communication  explanatory  of  delay. 
The  difficulty  heretofore  has  originated  in  the  mode  of  selection  adopted 
by  the  Nominating  Committee.  It  has  been  customary  for  gentlemen  to 
hand  in  their  names  and  the  proposed  subjects  on  slips  of  paper,  and  the 
committee,  without  further  investigation,  have  so  published  in  the  annual 
reports.  Thus  it  has  happened  that  appointments  have  been  most  injudi- 
ciously made,  and  gentlemen  to  whom  a  special  duty  has  been  assigned 
have  been  found  to  know  less  of  that  than  any  other  subject.  He  there- 
fore hoped  that  no  committee  of  last  year  would  be  re -appointed  or  con- 
tinued from  which  no  Report  had  been  had  and  no  communication  received. 

On  motion,  the  Nominating  Committee  was  unanimously  instructed  to 
act  upon  the  suggestions  of  the  chairman,  who  also  stated  that  there 
should  be  some  definite  expression  of  disapprobation  as  to  the  course  of 
those  gentlemen  who  had  volunteered  essays,  and  had  their  names  reported 
in  the  newspapers  and  spread  over  the  land,  and  then  paid  no  further  at- 
tention to  the  matter. 

Dr.  Flint,  from  the  Committee  on  Prize  Essays,  begged  leave  to  re- 
port that  they  had  received  four  dissertations  in  time  for  a  careful  and 
thorough  examination,  and  two  others,  quite  voluminous,  only  two  days 
before  the  meeting  of  the  Association.  The  latter  we  have  felt  constrained 
to  exclude  altogether  from  the  competition  of  the  present  year,  on  account 
of  the  absolute  impossibility  of  reading  them  with  a  critical  purpose  and 
effect.  The  others  have  been  carefully  examined  by  all  the  surviving 
members  of  the  Committee  —  one  estimable  associate.  Dr.  Evans,  having 
been  called  from  all  his  earthly  labors  before  the  active  duties  of  the 
Committee  began. 

More  than  one  of  the  four  essays  we  have  examined  exhibited  much 
labor,  and  a  commendable  scholarship  in  their  preparation — are  voluminous, 
and  in  some  respects  very  meritorious  papers ;  but,  in  the  unanimous 
judgment  of  the  Committee  neither  of  them  possess  the  degree  and  species 
of  merit  which  should  entitle  its  author  to  the  Association  Prize. 

The  Committee  beg  leave  furthermore  to  report  that,  in  their  opinion, 
and  as  the  suggestion  of  their  own  recent  experience,  the  Association 
should  determine,  in  more  precise  and  formal  manner  than  has  yet  been 
done,  the  terms  and  conditions  of  competition  and  of  success  in  the 
contest  for  prizes,  for  the  government  alike  of  contestants  and  the  com- 
mittee of  adjudication,  and  that  a  committee  be  now  appointed  to  consider 
and  report  upon  that  subject. 


120  Tlie  Peninsular  wul  Independent. 

Dr.  Gordon,  of  Ohio,  from  the  Committee  on  Epidemic  Cholera,  made 
an  interesting  written  Report;  which  wasjead,  approved,  and  referred  to 
the  Committee  on  Pubhcation,  and  the  request  of  Dr.  Gordon,  that  the 
Committee  be  continued,  was  referred  to  the  Committee  on  Nominations. 

Dr.  J.  B.  Lindsley,  Chairman  of  the  Committee  appointed  to  inquire 
into  the  propriety  of  dividing  the  Association  into  sections,  for  the  better 
performance  of  its  work  in  considering  the  various  branches  of  medicine 
and  surgery,  recommended  the  adoption  of  suc'n  a  plan  as  being  indispen- 
sably necessary  to  making  this  body  a  working  scientific  association. 
They  do  not  deem  it  necessary  to  enter  into  any  argument  in  favor  of 
this  plan,  it  being  the  one  already  universally  adopted  by  similar  bodies. 
They  would  simply  recommend,  for  the  present,  a  division  into  the  follow- 
ing sections,  as  being  most  suitable  to  facilitate  the  transaction  of  business, 
viz. : 

1.  Anatomy  and  Physiology. 

2.  Chemistry  and  Materia  Medica. 

3.  Practical  Medicine  and  Obstetrics. 

4.  Surgery. 

The  Committee  do  not  propose  that  this  subdivision  of  labor  shall  in 
any  manner  interfere  with  the  regular  business  of  the  Association  as  now 
conducted ;  but  only  that  after  having  assembled  each  day  in  general  ses- 
sion, each  section  shall  meet  separately  for  the  purpose  of  hearing  and  dis- 
cussing papers  on  such  subjects  as  properly  belong  to  them,  and  they 
therefore  recommend  that  the  Committee  of  Arrangements  for  the  ensuing 
year  be  requested  to  provide  suitable  accommodations  for  the  services  of 
these  sections,  and  that  each  of  said  sections  shall  be  authorized  to  make 
such  arrangements  as  may  be  required  for  the  proper  transaction  of  its 
business. 

This  Report  was  considered,  and  adopted  after  a  very  able  speech  in 
its  support  by  Dr.  Davis. 

Dr.  J.  W.  Singleton,  of  Ky.,  moved  the  suspension  oT  the  rules  for 
the  introduction  of  the  following  : 

Resolved,  That  in  the  death  of  Dr.  A.  Evans,  of  Kentucky,  the  As.«ociation  has  lost 
one  of  its  most  manly  and  efi5cient  members,  and  ^-ociety  a  friend  and  benefactor. 

The  resolution  was  unanimously  adopted. 

Dr.  W.  L.  Sutton,  imder  the  resolution  appointing  a  Committee  on 
registration  of  births,  marriages,  &c.,  proposed  a  plan  of  general  action, 
an  abstract  of  which  he  read  on  motion  of  Dr.  Gibbs,  of  S.  C,  and  on 
motion  of  Dr.  L.  P.  Yandell  the  subject  was  referred  to  a  committee,  to 
report  during  the  present  session. 

Drs.  Sutton,  Lindsley,  W.  R.  Gibbs,  Br3-an,  Pitcher,  and  Crosby 
were  appointed  such  committee. 

Dr.  Blatchford  stated  that  he  had  received  from  Dr.  Willard,  Secre- 
tary of  the  New  York  State  Medical  Society,  50  volumes  of  their  Trans- 
actions for  1850,  for  distribution  to  the  Medical  Press,  the  Medical  Col- 
leges, and  all  Medical  Societies  of  the  South,  and  sent  with  a  request 
for  an  interchange  of  civilities.  Gentlemen  present  can  be  supplied  by 
application  to  Dr.  Bemiss,  and  if  the  number  sent  be  not  sufficient  for 
the  supply  they  will  be  cheerfully  forwarded  to  any  gentleman  by  ap- 
plication to  the  Secretary,  Dr.  S.  D.  Willard,  Albany,  N.  Y.,  the  postage 
being  included  in  the  application,  which  is  twenty-two  cents. 

A  voluminous  report  from  Dr.  Thomas  Logan,  of  California,  on  Me- 
dical Topography  and  Epidemics,  was  received,  and  referred  to  the  Com- 
mittee on  Publication. 

The  Chairman  of  the  Committee  on  Voluntary  Essays  stated  that  he 
had  received  a  paper  on  a  case  of  extra-uterine  foetation  from  Dr.  Enos 


Tioelfth  Annual  Meeting  of  Am.  Med.  Association.     121 

Hoyt,  of  Transylvania,  Mass.,  and  another  on  a  case  of  accidental  poison- 
ing by  strychnine  from  Dr.  Douglas  Bly,  of  Rochester,  N.  Y.  He  also 
presented  a  very  voluminous  paper,  entitled  "Observations  on  some  of 
the  changes  of  the  Solids  and  Fluids  in  Malaria  Fever,  by  Joseph  Jones, 
Prof  of  Medical  Chemistry  in  the  Medical  College  of  Georgia,  at  Augusta." 
By  request.  Prof.  Jones  gave  a  verbal  abstract  of  his  paper  and  an  expo- 
sition of  his  theory ;  and  on  motion  of  D.  W.  Yandell  the  communication 
was  referred  to  the  Committee  on  Publication. 

Dr.  D.  W.  Yandell  announced  that  the  following  railroad  companies  had 
agreed  to  pass  delegates  to  this  Convention  over  their  roads  at  half  price : 
Pittsburgh,  Fort  Wayne,  and  Chicago;  Pennsylvania  Central;  Jefferson- 
ville ;  New  Albany  and  Salem :  Louisville  and  Nashville  ;  and  Cleveland 
and  Pittsburgh. 

On  motion,  a  vote  of  thanks  was  tendered  to  these  companies  for 
their  liberality. 

Dr.  J.  B.  Flint  offered  the  following  resolution: 

Whereas,  Our  brethren  of  Great  Britain  are  engaged  in  erecting  a  monument  to 
the  memory  of  John  Hunter,  whose  invaluable  services  in  behalf  of  Physiology  and 
Surgery  are  recognized  and  honored,  as  well  on  this  side  of  the  Atlantic  as  in  Europe  ; 
and  whereas,  this  Association,  as  the  representatives  of  American  Medicine,  would  re- 
joice in  some  suitable  manner  to  participate  in  so  grateful  a  testimonial  of  gratitude  and 
respect;  therefore. — 

Resolved,  That  a  committee  of  three  be  appointed  to  consider  in  what  manner  this 
participation  can  best  be  effected,  so  as  to  be  acceptable  to  our  British  brethren,  and 
consistent  with  our  own  means  and  opportunities  of  action,  with  instructions  to  report  at 
the  next  annual  meeting. 

The  resolution  was  adopted;  and  Drs.  Flint,  Bowditch,  and  Shattuck 
appointed  as  the  Committee. 

Dr.  Harvey  Lindsley  offered  the  following : 

Whereas,  Parliamentary  rules  of  order  are  numerous,  complicated,  sometimes 
obscure,  and  often  inapplicable  to  such  a  body  as  the  American  Medical  Association ;  and 
whereat",  from  the  nature  of  the  pursuits  of  medical  men,  they  can  not  be  familiar  with 
these  rules  :     Therefore, — 

Resolved,  That  a  Select  Committee  of  three  members  be  appointed  to  prepare  a 
system  of  rules  for  the  government  of  this  Association,  as  few  in  number,  as  concise  and 
perspicuous  as  possible,  to  bo  reported  to  the  next  annual  meeting. 

This  resolution  was  adopted,  and  Drs.  Lindsley,  Comegys,  and  Blatch- 
ford  appointed  as  the  Committee. 

The  paper  of  Dr.  Bly,  on  Accidental  Poisoning  by  Strychnine,  was 
read  by  its  author;  and  as  individual  cases  are  not  reported  in  the  journals 
of  the  Association,  thanks  were  returned  for  the  communication,  with  a 
request  that  it  be  published  in  some  medical  journal. 

An  invitation  from  Grand  Master  Morris,  of  the  Masons,  was  received, 
urging  Medical  brethren  to  attend  the  Masonic  Convention  now  in  session 
in  this  city. 

The  Nominating  Committee  made  the  following  report : 

The  next  annual  meeting  to  take  place  at  New  Haven,  on  the  first 
Tuesday  of  June,  1860.  Dr.  Eli  Ives  is  elected  Junior  Secretary. 

Committee  of  Arrangements  —  Drs.  Chas.  Hooker,  Stephen  G.  Hub- 
bard, and  Benjamin  Sullivan,  Jr.,  with  power  to  add  to  their  numbers. 

Committee  on  Prize  Essay's  —  Drs.  Worthington  Hooker,  Conn;  G. 
C.  Shattuck,  Mass. ;  Usher  Parsons,  R.  L ;  P.  A.  Jewett,  Conn. ;  and 
John  Knight,  Conn. 

Committee  on  Publication  —  Drs.  F.  G.  Smith,  Philadelphia,  Pa.; 
Wistar,  do. ;  Bemiss,  Louisville,  Ky. ;  Ives,  New  Haven,  Conn. ;  HoUings- 
worth  and  Hartshorne,  Philadelphia,  Pa. ;  and  Askew,  Wilmington,  Del. 

Committee  on  Medical  Literature  —  Drs.  Henry  Campbell,  Ga. ;  D.  F. 
Wright,  Tenn. ;  0.  Wendell  Holmes,  Mass. ;  S.  G.  Ormer,  Ohio ;  and  W. 
H.  Byford,  111. 


122  The  Peninsular  and  Independent. 

Committee  on  Medical  Education  —  Drs.  D.  M.  Reese,  New  York  ;  W. 
R.  Bowling,  Tenn. ;  Chas.  Fishback,  Ind. ;  John  Bell,  Penn. ;  Z.  Pitcher. 
Mich. 

The  following  Special  Committees  were  appointed  : 

On  Morbus,  Coxarius,  and  Surgical  Patliology  of  Articular  Inflammation — 
Dr.  Lewis  A.  Sayre,  of  New  York. 

On  the  Surgical  Treatment  of  Strictures  of  the  Urethra — Dr.  James  Brj-an,  of 
Philadelpliia. 

On  Drainage  and  Sewerage  of  Large  Cities,  their  Influence  on  Public  Health 
— Drs.  A.  J.  Semmes,  D.  C,  cliairman,  Comdius  Boyle,  and  G.  M.  Dove. 

On  the  Periodicity  of  Diseases  PrevaiUng  in  the  Mississippi  Valley — Dr.  J. 
W.  Singleton,  of  Smithland,  Ky. 

On  Puerperal  Tctjinus,  its  Statistics,  Pathology,  and  Treatment — Dr.  D.  L. 
McGugin,  of  Keokuk,  Iowa. 

On  Hospitjil  Epidemics — Dr.  R,  K.  Smith,  of  Philadelphia. 

On  Puerperal  Fever — Dr.  J.  N.  Green,  of  Stelisville,  Ind. 

On  Anjemia  and  Chlorosis — Dr.  H.  P.  Ayres,  of  Fort  "Wayne,  Ind. 

On  Ve'ratrum  Viridt — Dr.  James  B.  McCmw,  of  Richmond,  Va. 

On  Alcohol,  Its  Therapeutical  Effects — Dr.  J.  R.  W.  Dunbar,  of  Balti- 
more, Md. 

On  Meteorology — Dr.  J.  G.  "Westmoreland,  Atalanta,  Ga. 

On  Milk  Sickness — Dr.  Robert  Thomj)Sun,  Columbus,  Ohio. 

On  Manifestations  of  Disease  of  Nerve  Centres — Dr.  C.  B.  Chapman, 
Wisconsin. 

On  the  Medical  Topography  of  Iowa — Dr.  T.  0.  Edwards,  Iowa. 

On  Microscopic  Ouservations  on  Cancer  Cells — Dr.  Geo.  D.  Noiris,  New 
Market,  Ala. 

On  the  Philosophy  of  Practical  Medicine^ — Dr.  Chas.  Graham,  Cincinnati, 
Ohio. 

On  Some  of  the  Peculiaiities  of  the  North  Pacific  and  their  Relations  to 
Climate— Dr.  Wm.  H.  Doughty,  Ga. 

The  following  special  committees  were  continued  or  altered: 

On  Microscope — John  C.  Dalton,  Jr.,  N.  Y. ;  David  Hutchinson,  Ind. ;  A.  R. 
Stout,  Cal. ;  Calvin  Ellis,  Mass. ;  Christopher  Johnson,  Md. 

On  Diseases  and  Mortality  of  Boarding  Schools — Dr.  C.  Mattingly,  Ky. ;  and 
Dixi  Crosby,  N.  H. 

On  the  Various  Surgical  Operations  for  the  Relief  of  Defective  Vision — Drs. 
M.  A.  Pullen,  Mo. ;  T.  J.  Cogley,  Ind.,  and  W.  Hunt,  Penn. 

On  the  Blood  Corpuscle — Dr.  A.  Sager,  Michigan. 

On  American  Medical  Necrology — Dr.  C.  C.  Cox,  Maryland. 

On  the  Hygenic  Relations  of  Air,  Food,  and  Water,  the  natural  and  artificial 
causes  of  their  impurity,  and  the  best  methods  by  which  they  can  be  made  most 
efiectually  to  contribute  to  the  public  healtli — Dr.  C.  C.  Cox,  Maryland. 

On  the  Effect  of  Virus  of  Rattlesnake,  <fce.,  when  introduced  into  the  system 
of  Mammalia — Dr.  A.  S.  Payne,  Virginia. 

On  the  Climate  of  the  Pacific  Coast,  and  its  Modifying  Influences  upon  In- 
flammatory Action  and  diseases  generally — Dr.  0.  Harvey,  California. 

On  the  Constitutional  Origin  of  Local  Diseases,  and  the  Local  Origin  of 
Constitutional  Diseases — Drs.  W.  H.  McKee,  North  Carolina,  and  C.  F.  Hey  wood. 
New  York. 

On  motion  of  Dr.  Brodie,  Dr.  A.  J.  Semmes  was  requested  to  serve  as 
Secretary  pro  tern,  during  the  remainder  of  the  session. 

The  Association  took  up  the  special  order,  being  the  report  on  Medical 
Ethics,  to  which  had  been  referred  the  action  of  the  Dubuque  Medical 
Society,  which,  after  debate,  was  laid  over  until  12  o'clock  to-morrow. 

Amendments  to  the  Constitution  of  the  Association  were  then  taken 
up,  and  a  provision  was  acted  upon  that  no  individual  who  shall  be  under 
sentence  of  expulsion  or  suspension  from  any  State  or  Local  Medical 
Society,  of  which  he  may  have  been  a  member,  shall  be  received  as  a 


Twelfth  Annual  Meeting  of  Am.  Med,  Association.    123 

delegate  to  this  body,  or  be  allowed  any  of  the  privileges  of  a  member, 
until  he  shall  have  been  relieved  from  such  sentence  by  such  State  or 
Local  Society.     This  amendment  to  the  Constitution  was  adopted. 

The  next  amendment,  lying  over  from  last  year,  was  the  proposition 
of  Dr.  Kyle,  of  Ohio,  — 

That  the  Constitution  of  the  Association  be  so  amended  as  to  prohibit 
the  admission  as  a  delegate  or  the  recognition  as  a  member  of  any  person 
who  is  not  a  graduate  of  some  respectable  medical  college. 

This  amendment  was  rejected;  but,  on  the  question  of  reconsideration, 
a  long  and  animated  debate  ensued,  which  called  forth  all  the  oratorical 
abilities  and  much  of  the  personal  feelings  of  the  delegates.  Without 
arriving  at  a  vote,  the  Association  adjourned  for  dinner. 

The  following  gentlemen  have  been  admitted  to  the  Association  as 
members  by  invitation : 

Indiana:  B.  C.  Rowan,  N.  D.  Field,  John  S.  Rowe,  R.  Curran, 
D.  Wiley,  J.  A.  Windle,  A.  V.  Talbot,  J.  W.  Davis. 

Ohio :     W.  C.  Hall,  N.  B.  Davis. 

Tennessee:     J.  M.  Brannoch. 

Kentucly:  W.  N.  Garther,  S.  B.  Fields,  W.  S.  Cain,  J.  A.  Hodge, 
S.  B.  Merrifield,  Joshua  Gore,  H.  M.  Berkeley. 

MissotiTh:     J.  M.  Allen. 

Alabama:     Dr.  Boylman,  Dr.  Turney. 

Neio  Hampshire :     David  Kay. 

United  States  Army:     Charles  S.  Tripler. 

Afternoon  Session. 

Upon  the  re  -  assembling  of  the  Association,  the  discussion  was 
renewed  on  the  motion  to  reconsider  the  vote  by  which  the  amendment 
to  the  Constitution  was  negatived,  prohibiting  the  admission  as  a  delegate 
or  the  recognition  as  a  member  of  any  person  who  is  not  a  graduate  of 
some  respectable  medical  college. 

Dr.  Kincaid  moved  a  further  amendment,  to  insert  the  word  "  here- 
after" after  "prohibiting." 

Dr.  Askew,  of  Delaware,  one  of  the  Vice-Presidents  in  the  chair, 
ruled  the  amendment  out  of  order  at  the  present  stage,  or  until  the  Asso- 
ciation decide  upon  the  question  of  reconsideration. 

After  a  long  discussion.  Dr.  Davis,  of  Indiana  moved  to  lay  the  motion 
to  reconsider  on  the  table ;  which  was  carried,  97  yeas,  nays  not  counted. 
So  the  amendment  stands  registered. 

The  next  proposed  amendment  to  the  Constitution  was  that  suggested 
by  the  New  Jersey  Medical  Society,  asking  for  such  changes  as  would 
establish  a  Board  of  Censors  in  every  judicial  district  of  the  Supreme 
Court,  who  should  examine  and  grant  diplomas  to  all  proper  members  of 
the  Association. 

This  was  temporarily  laid  on  the  table,  for  Dr.  Crosby  to  offer  a  report 
of  the  Medical  Teachers'  Convention,  which  met  ori  Monday  last.  He 
strongly  recommended  a  committee  from  this  body  to  confer  with  the 
Teachers'  committee,  and  felt  great  confidence  that  something  beneficial 
to  medical  education  would  be  the  effect  of  such  conference. 

Dr.  Comegys  moved  the  appointment  of  a  committee  of  five  to  confer 
with  a  committee  of  Medical  Teachers,  and  report  at  the  next  annual 
meeting,  provided  that  no  medical  teacher  be  selected  on  the  part  of  this 
Association. 

This  again  gave  rise  to  an  excited  debate,  clearly  showing  that  there 
was  a  great  deal  of  bad  feeling  between  the  Professors  and  the  laymen  of 


124  The  Peninsular  and  Independent. 

the  profession.  Prof.  McDowell,  of  Missouri,  was  extremely  happy  in 
some  of  his  hits,  and  kept  his  auditors  in  a  roar  of  laughter.  He  acknow- 
ledged that  Philadelphia  and  New  York  had  the  advantage  of  location ; 
the  railroads  took  students  there  as  they  did  the  horses  and  cattle  of  the 
West,  and  sometimes  its  asses. 

Prof  Crosby,  of  Dartmouth  College,  contended  that  the  elevation 
of  the  standard  of  medical  education  depended  more  upon  practitioners 
than  the  colleges ;  if  bad  materials  were  sent  up  from  physicians'  offices 
for  Professors  to  model  into  physicians,  it  could  not  be  expected  that  good 
results  would  follow.  He  wanted  a  committee  of  conference,  not  based  on 
any  sectional  feelings,  and  he  believed  the  whole  matter  could  be  arranged 
satisfactoril)\ 

Dr.  D.  W.  Yandell  wished  to  reply  to  one  remark  of  Prof  Crosby,  as 
to  the  bad  materials  sent  by  private  teachers  to  the  colleges.  He  had 
himself  rejected  students  who  were  too  big  fools  to  be  made  physicians, 
and  these  same  persons,  in  a  few  months,  had  gone  to  some  of  the  colleges 
and   come   back   with   their   diplomas   in   their   pockets. 

After  a  very  eloquent,  appropriate,  and  conciliatory  speech  from 
Dr.  Davis,  the  resolution  of  Dr.  Comegys  was  unanimously  adopted. 

The  resolutions  from  the  New  Jersey  Medical  Society  were  then  taken 
from  the  table,  and  referred  to  the  Committee  of  Conference., 

Dr.  Davis  offered  a  resolution  instructing  the  same  committee  to 
confer  with  the  State  Medical  Societies,  for  the  purpose  of  procuring  more 
decisive  and  uniform  action  throughout  the  profession  in  carrying  into 
effect  the  standard  of  preliminary  education  adopted  by  this  Association  at 
its  organization  in  1847.     This  was  carried. 

Dr.  Gibbes,  from  the  committee  to  examine  into  a  Plan  of  Uniform 
Registration  of  I3irths,  Marriages,  and  Deaths,  offered  the  following  report: 

They  have  given  the  same  a  careful  consideration,  and  they  unanimously  recom- 
mend that  the  Report  be  adopted  and  referred  to  the  Committee  on  Publication. 

They  also  recommend  that  the  same  committee  be  continued,  with  instructions  to 
add  to  the  Hcport,  in  time  for  publication  in  the  ensuing  volume  of  Transactions,  a  form 
of  registration  law  which  may  be  likely  to  answer  the  requirements  of  the  several  States. 

Dr.  Sayre,  of  New  York,  offered  the  following : 

Wheeeas,  The  medical  profession  at  lar^e  have  an  interest  in  the  character  and 
qualijBcations  of  those  who  are  to  be  admitted  as  their  associates  in  the  profession; 
Therefore,  — 

Resolved^  That  each  State  Medical  Society  be  requested  to  appoint  annually  two 
delegates  for  each  college  in  that  State,  whose  duty  it  shall  be  to  attend  the  examination 
of  all  candidates  for  graduation ;  and  that  the  colleges  be  requested  to  permit  such 
delegates  to  participate  in  the  examination  and  vote  on  the  qualifications  of  all  such 
candidates. 

This  was  referred  to  the  Committee  of  Conference. 

The  paper  of  Dr.  Jones,  presented  at  the  morning  session,  was  taken 
from  the  Committee  on  Publication,  and  referred  to  the  Committee  on 
Prize  Essays. 

Dr.  Eve  moved  to  record  the  name  of  Dr.  Benj.  W.  Dudley  as  a 
permanent  member ;  which  was  adopted  by  a  unanimous  vote,  the  dele- 
gates all  rising  to  their  feet  in  token  of  respect. 

Adjourned  till  to-morrow  morning. 

The  followino;  members  of  the  Association  registered  their  names 
during  the  day : 

Indiana:  John  M.  Kitchen,  S.  Davis,  Geo.  W".  New,  J.  H.  "Wood- 
burn,  S.  M.  Linton,  C.  Brown,  A.  G.  Boynton,  F.  M.  Mothershead, 
T.  Bullard,   W.  W.  Hitt,   A.  J.  Mullen,   Jno.  M.  Hinkle,  J.  D.  Maxwell, 


Ticelfth  Amiual  Ifeeting  of  Am.  Med.  Association.     125 

Jno.  M.  Reily,   J.  A.  Windle,   B.  C.  Rowan,   L.  Ritter,   R.  Curran,   J.  W. 
Davis,  W.  T.  S.  Cornett,  A.  V.  Talbert. 

Missouri:    J.  M.  Allen,  E.  S.  Frazer. 

Iowa:     Wm.  Watson. 

JSfew   YorJc :     Daniel  G.  Thomas,  John  L.  Zabriskie,  M.  M.  Marsh. 

Alabama:     J.  N.  Turney. 

Pennsylvania :     W.  W.  Townsend,  Caleb  Swaine. 

Ohio:  Geo.  Mendenhall,  S.  G.  Armor,  E.  B.  Stevens,  L.  G.  Lecklider, 
W.  L.  Schneck,  J.  P.  Judkins,  D.  B.  Cotton,  W.  F.  Kincaid,  Jno.  Davis, 
W.  C.  Hull,  W.  B.  Davis,  P.  H.  Kelly,  Usher  P.  Leighton. 

United  States  Army  :     Charles  S.  Tripler. 

KentiicTty :  E.  0.  Brown,  S.  B.  Richardson,  A.  H.  Shively,  F.  Q. 
Montgomery,  J.  A.  Hodge,  W.  W.  Cleaver,  Hugh  Berkley,  S.  B.  Field, 
W.  N.  Garther,  Ed.  Richardson. 

Illinois :  F.  B.  Haller,  H.  Nance,  Thomas  Wilkins,  T.  D.  Fitch, 
C.  Jolinson,  D.  0.  McCord. 

Tennessee:     J.  M.  Brannoch. 

The  whole  number  of  delegates  in  attendance  is  therefore  301,  exclu- 
sive of  members  by  invitation. 

Second  Day's  Proceedings. 

Thursday,  May  5th,  1859. 

The  President  called  the  Association  to  order  at  9  o'clock,  and  the 
reading  of  the  minutes  of  yesterday  was  dispensed  with. 

The  first  business  in  order  was  an  amendment  to  the  Constitution, 
laid  over  from  last  year,  and  proposed  by  Dr.  T.  L.  Mason,  of  New  York, 
to  insert  in  the  first  line  of  the  second  paragraph  of  Article  2,  after  the 
words  "shall  receive  the  appointment  from,"  the  words  "any  medical 
society  permanently  organised  in  accordance  with  the  laws  regulating  the 
practice  of  physic  and  surgery  in  the  State  in  which  they  are  situated, 
and  consisting  of  physicians  and  surgeons  regularly  authorised  to  practice 
their  profession."  Also,  to  add  to  the  sixth  paragraph  of  the  same 
article  the  words  "but  each  permanent  member  of  the  first  class  desig- 
nated in  this  plan  of  organization  shall  be  entitled  to  a  seat  in  the 
Association,  on  his  presenting  to  this  body  a  certificate  of  his  good 
standing,  signed  by  the  Secretary  of  the  Society  to  which  he  may  belong 
at  the  time  of  each  annual  meeting  of  this  body. 

Dr.  Linden  A.  Smith,  of  New  Jersey,  said  amendments  to  the 
Constitution  should  be  adopted  with  care,  and  though,  perhaps,  that  now 
proposed  might  be  desirable,  still,  as  Dr.  Mason  who  had  proposed  it,  was 
not  present  to  explain  his  views,  he  moved  that  the  subject  be  laid  over 
until  next  year.     This  suggestion  was  adopted. 

Another  constitutional  amendment,  proposed  by  Dr.  Henry  Harts- 
home,  of  Pennsylvania,  and  laid  over  from  last  year  under  the  rules, 
provides  to  add  to  the  second  article  the  words :  "  No  one  expelled  from 
this  Association  shall  at  any  time  thereafter  be  received  as  a  delegate  or 
member,  unless  by  a  three-fourths  vote  of  the  members  present  at  the 
meeting  to  which  he  is  sent,  or  at  which  he  is  proposed." 

This    amendment   was   adopted. 

Another  amendment  proposed  by  J.  Berrien  Lindsley,  of  Tennessee, 
was  called  up,  to  omit  in  Article  2  the  words  "  medicar  colleges,  hospitals, 
lunatic  asylums,  and  other  permanently  organized  medical  institutions  in 
good  standing  in  the  United  States,"  and  also  to  omit  the  words  :  "  The 
faculty  of  every  regularly  constituted  medical  college  or  chartered  school 
of  medicine  shall  have  the  privilege  of  sending  two  delegates.     The  pro- 


,126  The  Peninsular  and  Inde^jendent. 

fessional  staff  of  every  chartered  or  municipal  hospital  containing  an 
hundred  inmates  or  more  shall  have  the  privilege  of  sending  two  delegates, 
and  every  other  permanently  organised  medical  institution  of  good  stand- 
ing shall  have  the  privilege  of  sending  one  delegate." 

This  was  laid  on  the  table  until  the  next  annual  meeting. 

An  invitation  was  received  from  Mons.  Groux,  requesting  the  delegates 
to  meet  him  at  the  hall  of  the  University  at  noon  to-day,  to  witness 
experiments  on  his  congenital  fissure  of  the  sternum;  which  was  deferred- 
until  four  o'clock  this  afternoon,  as  the  Association  had  previously  accepted 
the  hospitality  of  Mr.  and  Mrs.  Robert  J.  AVard  at  the  former  hour. 

Dr.  McDermont  submitted  the  following  resolutions : 

•  Whereas,  A  vast  proportion  of  the  disease  and  misery  that  afflict  our  race  is 
caused  by  the  excessive  use  of  intoxicating  liquors ;  and  whereas  in  the  opinion  of  this 
Association  the  evils  of  intoxication  can  be  most  effectually  remedied  by  the  establish- 
ment of  Inebriate  Asylums,  wherein  the  victims  of  intemperance  may  bo  subjected  to 
Buch  restraints  and  treatment  as  shall  effect  a  thorough  reformation  of  their  habits  ; 
therefore, — 

Resolved,  That  this  Association  recommend  the  establishment  of  Inebriate 
Asylums  in  the  various  States  of  the  Union. 

Resolved,  That  the  State  and  County  Medical  Societies,  and  all  members  of  the 
medical  profession,  be  requested  to  unite  in  diffusing  among  the  people  a  better  knowledge 
and  appreciation  of  the  beneficent  purposes  and  important  benefits  that  would  be  confer- 
red upon  society  by  the  establishment  of  such  Asylums  throughout  the  various  sections 
of  the  country. 

This  resolution  was  referred  to  the  mover,  as  a  special  committee, 
with  a  request  that  he  would  report  thereon  at  the  next  meeting  of  the 
Association. 

Dr.  Shattuck  offered  the  following,  which  was  adopted : 

Resolved,  That  the  committee  appointed  in  May,  1S57,  on  Criminal  Abortion,  be 
requested  to  continue  their  labors,  and  especially  to  take  all  measures  necessary  to  carry 
into  effect  the  resolutions  reported  by  them  on  the  first  day  of  the  meeting. 

Dr.  Yandell,  from  the  Committee  on  Voluntary  Essays,  made  a 
further  report  that  a  communication  had  been  received  from  Dr.  Langer, 
of  Iowa,  on  Subentaneous  Injections  as  remedials;  which,  on  motion, 
the  author  read. 

The  essay  was  referred  to  the  writer  as  a  special  committee,  with 
the  request  that  he  would  report  further  at  the  next  annual  meeting  of 
the  Association,  and  continue  his  investigations. 

Invitations  to  visit  the  Insane  Asylum,  and  the  Library  and  Museum 
of  Transylvania  University,  were  received. 

The  President  appointed,  as  the  committee  of  conference  to  meet  the 
committee  from  the  Teachers'  Convention,  the  following  gentlemen:  Dr. 
Blatchford,  Troy,  N.  Y. ;  Condie,  Philadelphia,  Pa. ;  Bozeman,  Montgo- 
mery, Ala. ;  Brodie,  Detroit,  Michigan ;  and  Sneed,  Frankfort,  Ky. 

Dr.  D.  Meredith  Reese  from  the  Nominating  Committee  made  the 
following  final  Report: 

Special  Committees  continued: 

On  Quarantine  —  Drs.  D.  D.  Clark,  Penn. ;  Snow,  R.  I. ;  Jewell, 
Penn. ;  Fenner,  La. ;  and  Houck,  Md. 

On  Medical  Ethics  —  Drs.  Schuck,  Penn. ;  Murphy,  Ohio ;  Linton, 
Mo.  ;  Powell,  Ga. ;  Eve,  Tenn. 

On  Tracheotomy  in  Membranous  Croup — Dr.  A.  Y.  Dougherty,  N.  J. 

On  the  Effects  of  Lithotomy,  Performed  in  Childhood,  upon  the 
Sexual  Organs  in  After  Life — Dr.  White,  Memphis,  Tenn. 

On  Mercurial  Fumigation  in  Syphilis — Dr.  D.  W.  Yandell,  Louis- 
ville, Ky. 

On  the  Improvements  in  the  Science  and  Art  of  Surgery,  made 
during  the  last  Half  Century — Dr.  Jos.  McDowell,  St.  Louis,  Mo, 


Twelfth  Annual  Meeting  of  Am.  Med.  Association.     127 

On  the  Cause  and  Increase  of  Crime  and  Its  Mode  of  Punishment 
—Dr.  W.  C.  Sneed,  Frankfort,  Ky. 

On  the  Education  of  Imbecile  and  Idiotic  Children — Dr.  H.  P.  Ayres, 
Fort  Wayne,  Ind. 

On  the  Uses  and  Abuses  of  the  Speculum  Uteri — Dr.  C.  H.  Spill- 
man,  of  Kentucky. 

On  the  Topography  of  Vermont — Dr.  Perkins,  of  Vermont. 

On  the  Pons  Varolii,  &c.— Dr.  S.  B.  Richardson,  of  Kentucky,  and 
Dr.  Fishback,  of  Indiana. 

On  the  Physical  Effects  of  the  Hydro  -  Carbons— Dr.  F.  W.  White, 
of  Illinois. 

On  the  Effect  of  the  Periodical  Operations  for  Urinary  Calculi  upon 
Procreation  in  the  Male — J.  S.   White,  of  Tennessee. 

The  paper  from  Dr.  Ellis,  of  Massachusetts,  on  the  subject,  "Does 
the  microscope  enable  us  to  make  a  positive  diagnosis  of  Cancer,  and 
what  if  any  are  the  sources  of  error?"  was  referred  to  the  special 
committee  on  the  microscope,  of  which  Dr.  Dalton  is  chairman. 

Honorary  resolutions  were  passed  to  the  memory  of  the  following 
members  of  the  Association,  deceased :  Dr.  W.  W.  Bowling,  of  Alabama ; 
Dr.  Thomas  D.  Mutter,  of  Penn. ;  Dr.  P.  C.  Gaillard,  of  S.  C. ;  Dr. 
Jabez  G.  Goblc,  of  New  Jersey;  Dr.  John  K.  Mitchell,  of  Penn. 

Dr.  R.  K.  Smith,  of  Philadelphia,  submitted  the  following : 

Resolved^  That  the  death  of  Dr.  John  K.  Mitchell,  one  of  the  members  of  this  Asso- 
ciation, has  been  to  this  body  a  loss  keenly  felt  by  every  man  who  knew  him.  His  emi- 
nence as  a  teacher,  his  varied  acquirements  in  every  department  of  learning,  and  his 
generous  social  qualities  in  every  relation,  endeared  him  to  every  member  of  the  profes- 
sion who  had  the  pleasure  of  his  personal  acquaintance. 

Resolved,  That  the  family  be  notified  of  the  action  of  this  Association. 

Other  more  formal  resolutions  were  offered  and  feeling  eulogies 
pronounced. 

Dr.  Sayre  offered  the  following,  which  were  adopted  by  acclamation : 

Resolved,  That  the  thanks  of  the  American  Medical  Association  are  eminently  due 
and  are  hereby  presented  to  the  citizens  of  Louisville,  Ky.,  for  the  princely  hospitality 
publicly  and  privately  extended  to  the  members  of  this  body  during  its  present 
session. 

Resolved,  That  to  the  Committee  of  Arrangements,  and  to  the  profession  of  Louis- 
ville generally,  our  thanks  are  due  for  their  kind  and  assiduous  attention  to  the  Asso- 
ciation and  for  the  hearty  welcome  with  which  they  have  greeted  our  convention  in  their 
flourishing  city. 

After  the  transaction  of  some  other  unimportant  routine  business, 
On  motion  of  Dr.  Davis,  the  Association  adjourned,  to  meet  at  New 
Haven  on  the  first  Tuesday  in  June,  1860. 

The  registration  book  during  the  day  announced  the  names  of  Drs. 
D.  G.  Thomas,  of  New  York ;  William  S.  Cain,  of  Kentucky,  and  Peter 
Allen,  R.  K.  McMeans,  and  W.  R.  Kable,  of  Ohio — making  305  mem- 
bers in  attendance  during  the  session  of  the  Association. 


» ♦  ♦- 


NEWS    ITEMS. 


It  is  commonly  believed,  and  it  is  stated  in  many  chemical  works, 
that  charcoal  is  antiseptic.  This,  according  to  Dr.  Stenhouse,  is  the  very 
reverse  of  the  fact,  as  shown  by  the  condition  of  the  bodies  of  animals 
which  have  been  long  buried  in  charcoal,  which  are  usually  in  an  advanced 


128  The  Peninsular  and  Independent. 

stage  of  decay.  This  opinion  has  doubtless  arisen  from  the  fact  that  char- 
coal absorbs  the  gases,  and  thus  prevents  any  disagreeable  efiluvia. . 

The  statistics  of  Ohio  for  the  year  1858,  show  that  the  number  of  suicides 
in  that  State  was  sixty  in  all,  or  one  in  every  forty  thousand  of  the  popu- 
lation.  The  mode  of  suicide  is  mainly  confined  to  hanging,  drowning,  cut- 
ting the  throat,  shooting,  and  poison.  Of  the  suicides  in  Ohio,  the  mode  se- 
lected by  seventeen  was  that  of  hanging,  seven  by  drowning,  six  by  cutting 
the  throat,  and  ten  by  poisoning;  the  remaining  modes  wei-e  generally 
some  violence  occasioned  by  delirium  tremens  or  intoxication.  The  suicides 
in  cities  appear,  as  a  general  fact,  to  be  much  more  numerous  than  in  the 
country,  as  for  example — in  New  York,  1  in  10,500;  in  Cincinnati,  1  in 
15,000;  in  London,  1  in  6,000:  in  Paris,  1  in  2,100.  The  number  of  sui- 
cides given  for  Europe,  by  Balbi,  some  twenty  years  since,  was  as  follows: 
in  France,  1  in  20,000;  in  Austria,  1  in  20,000;  in  Prussia,   1  in  15,000; 

in  Russia,  1  in  49,000.  A  curious  libel  suit  has  recently  come  off  in 

Paris.  Twelve  homeopathic  physicians  sued  the  Union  MedicaJe  for  having 
asserted  that  homeopathy  was  "neither  a  doctrine,  nor  a  science,  but  a 
trade,"  and  that  "if  an  epoch  had  ever  presented  itself  at  which  the  me- 
thod of  Uanneman  could  be  employed  b}^  any  one  who  was  not  abjectly  ig- 
norant— a  crack-brained  visionary,  or  a  wretched  charlatan — it  was  certainly 
not  the  present  one."  The  editors  and  proprietors  of  the  Union  Aledicale 
pleaded  by  way  of  defense  and  justification,  that  what  they  had  stated  was 
only  the  truth.  The  tribunal  before  which  the  suit  was  brought,  without 
passing  any  judgment  on  the  respective  sj'stcms  of  allopathy  and  homeo- 
pathy, held  that  the  plaintiffs  had  no  ground  of  action,  and  dismissed  the 

case  with  costs.  The  number  of  persons  now  known  to  have  been 

been  poisoned  by  eating -the  lozenges  having  arsenic  in  them,  at  Bradford 
(Eng.),  is  225,  of  whom  eighteen  have  died.  Five  or  six  others  are  still 
suffering  from  the  effects  of  the  poison,  and  the  recovery  of  two  of  them 

is  doubtful.     Of  the  poisoned,   130  were  adults.  Chloroform  has 

been  administered  thirty  tliousand  times  in  the  hospitals  of  London,  during 

the  last  ten  years,  for  the  performance  of  surgical  operations.  The 

Microscopists  of  Germany  have  entered  into  an  arrangement,  by  which, 
once  a  year,  an  exchange  of  microscopical  specimens  takes  place.  At  the 
last  meeting,  twenty-four  Microscopists  were'prcsent,  and  3000  preparations 

offered  in   exchange. Some  of  the  European  journals  are  making 

merry  over  the  fact  that  a  iconwn  has  sent  to  the  Academy  of  Medicine, 
Paris,  a  suf>2^ensoriuin  scroti !    The  inventorcss  submits  it  to  the  approval 

of  the  Medical  Faculty,  assuring  them  that  it  is  a  masterpiece. The 

odorous  principle  of  the  Vanilla  bean,  which  has  been  supposed  to  be  form- 
ed by  a  sort  of  fermentation  during  the  curing  of  the  bean,  is  proved  by 
GoBLEY  to  pre-exist  in  it,  in  the  form  of  a  crystalline  principle,  somewhat 
analogous  to  the  coumarin  of  the  Tonka  bean,  and  which  he  has  named 

Vanillin.  Chemical  matches  have  been  introduced  into  Europe  by 

a  chemist  (M.  Canouil),  which  are  made  without  white  or  red  phosphorus 
or  other  poison.  They  are  formed  essentially  of  chlorate  of  potash,  mixed 
with  a  small  quantity  of  a  metallic  peroxide,  bichromate,  or  oxysulphuret, 
when  it  is  desired  to  render  them  more  inflammable.  These  matches  dif- 
fuse no  odor,  either  in  the  manufacture  or  in  the  use.  They  Hght  without 

explosion  or  projection. X  whaling  vessel  arriving   at   Nantucket 

last  fall,  brought  750  pounds  of  Ambergris,  taken  from  one  whale.  It  was 
sold  to  a  Boston  drug-house  for  $10,000.  This  substance  is  a  morbid  se- 
cretion of  the  Spei'maceti  whale.  It  is  generally  found  in  whales  of  a  lean 
and  sick  appearance ;  indicating  that  the  Ambergris  is  the  product  of  dis- 
ease; and  usually  in  lumps  of  from  one  to  thirty  pounds  weight.  The 
largest  piece  hitherto  known  weighed  182  pounds,  and  was  bought  by  the 
Dutch  East  India  Company  of  the  King  of  Tidore.  Another  piece,  from 
the  inside  of  a  whale  killed  near  the  ATindward  Islands,  was  sold  for  ^2500. 


THE 


PENINSULAR  and  INDEPENDENT 


MEDICAL  JOURNAL. 


Vol.  II.  DETROIT,-  JUNE,  1859.  No.  3. 


riginal  Cffmrannitations. 


-•♦^- 


ART.  II.— Report  to  the  State  Medical  Society  on  Criminal  Abortions. 

^  By  E.  P.  Christian,  M.  D. 


Messrs.  Editors:  —  My  apology  for  sending  the  following  Report, 
corrected  and  comjiJeted,  for  publication  in  the  Journal,  is  not  on  account 
of  the  egregious  orthographic  and  grammatical  liberties  taken  with  the 
copy  in  the  published  Transactions  of  the  State  Medical  Society  —  for,  as 
regards  these,  I  could  have  contented  myself  with  having  fellow  -  suffer- 
ers— but  it  is  rather  that,  by  cutting  it  in  two  in  the  middle,  the  whole 
point  of  it  was  lost,  and  it  would  have  served  a  far  better  purpose  to 
have  published  the  latter  half  than  the  former. 

It  was  certainly  a  very  bold  liberty  to  take,  but  evidently  the 
matter  was  not  scrutinized  by  any  proof-reader  at  all. 

Owing  to  the  fact  of  not  having  the  manuscript  by  me,  I  have 
been  unable  to  make  a  true  copy,  but  the  addition  now  made  to  the 
Report  as  published  in  the  Transactions  embraces  all  that  was  omitted 
from  the  original  paper.  E.  P.  0. 

Wyandotte,  May  18,  1859. 


At  the  last  meeting  of  this  Association,  the  writer  was 
appointed  to  report  at  this  meeting  on  Criminal  Abortions. 
A  snhject   so  indefinitely  stated,  occasions   an   uncertainty 

Vol.  11. -I. 


130  The  Peninsular  and  Independent, 

as  regards  the  special  design  of  such  a  Keport,  and  gives 
to  the  reporter  no  small  amount  of  discretionary  power  in 
his  choice  of  the  manner  in  which  the  subject  is  to  be 
considered.  From  the  simple  statement  of  the  subject  in 
such  general  terms  it  could  not  be  known  whether  the 
Report  was  expected  to  treat  of  the  causes,  and  means  of 
prevention,  of  Criminal  Abortion,  or  of  the  best  and  safest 
mode  of  procuring  it,  or  of  any  other  particular  mode  of 
consideration. 

I  have  chosen  to  consider  some  of  the  special  causes  of, 
and  incentives  to,  the  commission  of  this  crime,  and  the 
remedy,  the  means  of  prevention  thereby  suggested.  I 
shall  not  infringe  upon  the  province  of  medical  jurispru- 
dence to  treat  of  the  legal  nature  of  this  crime,  and  to 
define  what  constitutes  it,  &c.  I  simply  state  that  our 
statutes  make  it  penal  for  any  one  to  attempt  to  joroduce 
miscarriage  without  the  advice  of  two  medical  men  that  it 
is  necessary  to  preserve  the  life  of  the  mother.  No  person, 
not  even  a  medical  man,  is  authorized,  or  justified,  in  at- 
tempting to  procure  it  on  his  own  judgment  and  his  own 
responsibility  alone.  Yet,  though  such  cases  are  penal, 
they  are  not  to  be  considered  in  the  class  of  Criminal  Abor- 
tions here  treated  of.  I  have  reference  to  deliberate  and 
premeditated  destruction  of  an  embryo,  unnecessary  on 
account  of  the  life  or  health  of  the  mother. 

We  are  not  so  Utopian  as  to  anticipate,  very  speedily, 
that  condition  of  society  in  which  this  crime  shall  be  un- 
known, nor  do  we  expect  its  complete  cessation  by  other 
means  than  by  such  as  we  hope  to  check  the  commission 
of  all  crime  —  not  by  penal  codes,  but  the  universal  'faith- 
ful Christian  observance  of  the  whole  Divine  decalogue. 

And  yet,  as  there  are  strong  and  peculiar  reasons  for 
the  occurrence  of  this  crime,  even  in  an  otherwise  moral 
community,  so,  on  the  other  hand,  are  there  strong  and 
peculiar  reasons  for  hoping  to  effect  its  prevention ;  and  the 


'     Christian  07i  Criminal  Abortions.  131 

ineans  of  effecting  this  lie  almost  entirely  with  the  Medical 
Profession.  It  comes  peculiarly  within  the  physician's  mis- 
sion, no  less  than  in  ministering  to  the  relief  of  disease  and 
suffering.  The  means  for  use  are  within  his  power ;  and  the 
responsibility  rests  upon  him  for  a  proper  use.  We  do 
not  propose  any  severer  legal  penalties  as  a  means  of  its 
prevention.  The  enactments  are  already  sufficiently  rigor- 
ous, and  all  experience  shows  that  crime  is  not  so  entirely 
prevented  by  severity  of  penalties,  and  least  of  all  could 
we  expect  this  crime  to  be  so  influenced.  We  would,  how- 
ever, make  patent  and  conspicuous  Nature's  penalties — the 
moral  and  physical  penalties  which  can  not  be  evaded — by 
far  more  terrible  than  any  legal  penalty  that  can  be  applied, 
and  a  just  appreciation  of  which  would  do  more  towards 
preventing  this  crime  than  Draconian  laws.  This  is  what 
belongs  to  the  physician,  and  is  wherein  his  duty  and 
responsibility  lie. 

But  though  we  propose  no  severer  penalties,  we  do  not 
consider,  by  any  means,  our  statute  as  unamenable  to  criti- 
cism, and  incapable  of  being  bettered,  for  it  displays  the 
relics  of  barbarism,  being  based  upon  ignorance  and  a  physi- 
ological lie. 

What,  then,  is  a  query  next  suggested,  are  the  peculiar 
circumstances  bearing  on  this  crime,  which  prompt  to  its 
commission,  and  occasion  its  prevalence  amongst  all  classes 
of  society,  even  in  intelligent  and  reputably  moral  commu- 
nities, and  which  render  it  less  liable  to  be  influenced  by 
the  nature  of  the  penalty  imposed  than  other  crimes.? 

1st.  Ignorance  of  the  true  nature  of  the  crime,  and  of 
the  real  guilt  attaching  to  it;  a  morbid,  illicit  perversion 
of  the  moral  sense  on  this  matter,  or  rather,  perhaps,  an 
uneducated  and  undeveloped  moral  status  in  regard  to  it. 
It  is  surprising  how  little  guilt  is  attached  to  the  crime  of 
infanticide  among  all  nations,  civilized  as  well  as  barbarous! 
This    is  evinced   by   its    so    frequent   occurrence  among  all 


132  The  Peninsular  and  Independent. 

communities,  and  by  its  being  an  established  custom  among 
some  nations,  and  a  custom  whose  observance  is  not  only- 
laudable,  but  regarded  as  an  act  of  obedience  to  Divine 
will.  However  we  may  account  for  such  a  perversion  of 
natural  feelings  and  of  moral  sense,  which  would  not  be 
difficult  to  do,  it  has  its  existence  and  influence ;  and  where 
infanticide  is  regarded  so  lightly,  how  much  less  importance 
is  attached  to  the  destruction  of  foetal  life  where  ignorance 
of  the  physical  penalties  is  almost  universal. 

2d.  Why  is  it  less  liable  to  be  influenced  by  the  nature 
of  the  penalty  imposed  ?  For  several  reasons.  As  a  gene- 
ral fact  we  may  state  that  the  frequency  of  any  particular 
crime  will  be  governed  by  the  special  temptations  to  its 
commission,  and  by  the  risk  of  detection  and  punishment. 
As  regards  the  risk  of  detection  and  punishment,  we  shall 
presently  show  why,  in  these  cases,  it  is  particularly  small ; 
but  even  the  certainty  of  conviction  and  suflering  the  pen- 
alty of  crime,  does  not  avail  to  prevent  its  commission 
when  the  temptation  is  strong.  Human  nature,  under  the 
influence  of  ungoverned  passion,  takes  no  thought  of  the 
legal  penalties,  and  much  less  of  the  natural  j^enalties ;  and 
strong  and  prevailing,  too,  must  be  the  moral  sense  where 
the  commission  of  an  error  or  a  course  of  erroneous  action^ 
and  escape  from  detection,  will  not  render  more  facile  the 
commission  of  a  second,  with  the  prospect  of  eradicating 
the  evidences  of  the  former  and  the  latter.  Facilis  de- 
scensus Averni  is  a  trite  quotation  from  the  heathen  writer, 
no  less  philosopher  than  poet;  but,  like  an  algebraic 
formula  in  mathematics,  expresses  in  the  fewest  and  truest 
words  this  downward  tendency.  Shame,  the  wish  and 
expectation  of  escaping  the  scorn  and  ridicule  of  the  world, 
when  the  moral  sense  has  been  seared,  proves  as  great  an 
incentive  to  crime  as  passion  itself.  Do  I  say  too  much 
in  stating  that  capital  crimes  are  as  frequently  thus 
prompted  as  by  passion  itself  ?      How  many  murders,  rob-- 


Christian  on  Criminal  Abortions.  V6% 

beries,  arsons,  &c.,  are  prompted  by  the  hope  and  expecta- 
tion of  concealing  and   repairing  the  wrongs  originated   in 
the  drinking  -  room  and  at  the  gaming-table.      Since,  then, 
statute  Hpan    statute,  and   jDenaltj  upon  penalty,  can   not 
effect   the  suppression   of  ordinary   crimes,  how   much   less 
would  naturally   be  their  influence  upon  one  of  this   char- 
acter, where,  in   a  large  proportion  of  cases,  the  discovery 
of  the  error  which   is  sought    thereby   to  be   concealed,  is 
held  as  a  greater  punishment,  a  more  dreadful  alternative, 
than  any   the  law  can   inflict.      Not  only,  too,  is  there   in 
many  cases  the  expectation  of  concealing  former  errors,  and 
of  escaping  the  scorn  and   ridicule  of  the  community,  but 
of  escaping  the  cares  and  anxieties  of  maternity' — to  many, 
even  in  the  bonds  of  wedlock,  no  small  temptation,  when 
depressed   by  poverty  and   harrassed  with   the  cares  of  an 
already  large  family,  or  perhaps  of  an  ill -mated,  intemperate, 
or  improvident  husband  ;    and  how  much  greater,  then,  to 
one   having  no   husband's  sympathies   or   succor,  and   only 
cold  and   ungenerous  contempt   and   disdain  to   anticipate ! 
As  regards  the  risk  of  detection  and  punishment,  the  dan- 
ger is  in  reality  small — if  in  a  married  woman,  how  insig- 
nificantly small  is  it.?      Where  is  the  memory,  and  where 
the  records  of  punishment   of  such  a  case  ?      And  yet,  as 
regards  its  frequency,  let  any  medical  man,  for  an  answer, 
consult   the  record   of  the  applications   made   to  him,  and 
the  physical  evidences  he  has  observed  in  sufl*erings  he  has 
been   called   upon   to   relieve.      We   might   ask  where   and 
when   has   been  a  conviction  in   any  case,  except  when    of 
more   than  ordinary   malignity,  as  where  a  double   murder 
has  been  committed  of  both  mother  and  child,  which   has 
spasmodically  excited  public  feeling  to  a  higher  pitch  than 
usual  ?      And  is  not  a  conviction  in  such  cases  the  excep- 
tion ?      Most  certainly  it  is ;  and  I  am  ignorant  of  any  such 
in   our   State,  though   arraignments   have   been   made,  and 
.justice  has  aemanded  satisfaction.      But  usually  the  risk  is 


134  The  Peninsular  and  Independent. 

in  reality  small;  and  from  this  very  fact  the  temptation 
becomes  the  stronger.  The  crime  is  against  a  being  that, 
as  yet,  has  attached  itself  to  no  one  by  strong  ties  of  sym- 
pathy or  interest.  There  are  none  so  strongly  bound  to 
it  that  their  friendship  prompts  them  to  care  for  its  rights 
or  avenge  its  wrongs.  Its  natural  protectress  —  she  who 
should  guard  it  from  evil  and  administer  to  its  wants — be-, 
comes  the  agent  of,  or  accessory  to,  the  crime.  The  friends 
of  the  agent,  if  cognizant,  are  urged  by  interest  to  prevent 
disclosure. 

Again,  we  have  observation  and  experience  to  the  full 
to  show  us  that  enactments  against  what  are  not  repugnant 
to  the  common  ideas  of  morality  of  a  large  part  of  the 
community,  unless  a  palpable  and  unequivocal  benefit  is 
sought  thereby  to  be  conferred  on  a  larger  part,  are  a 
complete  nullity.  Look,  for  example,  at  the  enactments 
against  liquor  vending,  against  Sabbath  breaking,  profane 
swearing,  &c. ;  and  this  is  the  case,  as  we  have  before  stated, 
on  this  subject.  The  fact  is,  and  a  lamentable  one  it  is, 
that  with  a  large  number  of  otherwise  moral,  intellectual, 
and  respectable  individuals,  it  is  not  considered  at  all  as  a 
crime — hardly  as  a  misdemeanor :  an  individual  who  would 
shudder  at  the  thought  of  maiming  a  brute — who  could 
not  look,  unmoved  by  pity,  upon  the  writhings  of  an 
entrapped  mouse — will  willingly  and  eagerly  submit  to, 
and  aid  in,  the  unnecessary  destruction  of  a  vital  embryonic 
human  being — her  own  offspring — to  which  she  should  be 
attached  by  the  strongest  feelings  which  God  has  implanted 
in  her  breast.  Oh,  blush  Humanity! — how  much  less  hu- 
man in  this  than  the  Brute  creation ! 

The  state  of  public  sentiment  on  this  subject,  and  the 

insufficiency  of  mere  penal  enactments  may  be  exhibited  by 

a  statement  of  very  competent   authority  on   this  point, — » 

Alf.  S.  Taylok,  author   of  a   standard   work   on  medical 

jurisprudence.     Says  he : 


Christian  on  Criminal  Abortions.  135 

*'Most  trials  for  child  -  murder  end  in  the  escape  of  the  prisoner. 
She  is  acquitted  of  the  murder,  in  opposition  to  the  strongest  evi- 
dence against  her,  and  found  guilty  of  concealment  of  birth ;  so  that  no 
other  punishment  is  inflicted  than  that  to  which  a  female  would  be 
sentenced  who  had  been  secretly  delivered  of  a  child  that  had  died  from 
natural  causes,  and  the  body  of  which  she  had  afterwards  concealed. 
But  can  the  former  serious  crime  be  placed  in  comparison  with  a  trivial 
offense  of  this  description?" 

This  exhibits  the  strong  disinclination  of  juries  to  convict 
of  infanticide ;  and,  a  fortiori,  how  much  stronger  the  dis- 
inclination to  convict  of  foeticide,  when  the  law  makes  the 
distinction  of  calling  the  former  murder,  which  in  the  latter 
would  be  only  manslaughter,  and  that,  too,  only  after 
quickening. 

The  ignorance  and  abnormal  sentiment  —  we  hardly  wish 
to  characterize  it  as  immorality  —  which  results  therefrom,^ 
pervades  all  ranks.  Newspaper  proprietors  exhibit  it  in  a 
lamentable  degree,  or  else  are  thrice  guilty  in  accepting 
pieces  of  silver  as  the  price  of  innocent  blood.  We  refer 
to  the  glaring  advertisements  to  be  daily  perused  in  promi- 
nent corners  of  even  the  most  respectable  journals,  of  safe 
and  ready  means  of  effecting  this  purpose.  For  example, 
such  as  the  following : 

"This  medicine,  to  married  ladies,  is  invaluable,  as  they  (it)  will, 
in  all  cases,  bring  on  the  monthly  flow  with  regularity." 

Thus  is  the  crime  encouraged  and  fostered. 

The  dealing  in  lotteries  of  any  kind  is  contrary  to  our 
laws,  and  even  their  advertisement  is  prohibited ,  and  why 
is  it  that  such  advertisements  as  these — far  more  pregnant 
with  evil,  with  wickedness,  with  perdition,  are  tolerated 
and  so  openly  displayed — destructive  to  morality  and  de- 
bauching to  innocence.^ 

But  this  is  not  alone  where  our  legislators  have  been 
remiss.  The  same  ignorance  and  its  consequences  has 
pervaded   oiir  legislative  halls^  where  we  ought  reasonably 


136  '     The  Peninsular  and  Independent. 

to  look  for  the  most  intelligent  representation  of  community. 
It  is  there  manifested  in  the  character  of  the  enactments 
on  this  subject,  which  thence  emanate,  and  exert  their  influ- 
ence over  community.  The  character  of  the  laws  in  a 
self-governing  people  is  the  rejflex  of  the  intelligence  and 
morality  of  the  people ;  and,  as  such,  what  is  our  exhibit 
is  this  respect  ?      Here  is  our  statute : 

[5742.]  Sec.  32.  The  willful  killing  of  an  unborn  quick  child  by 
any  injury  to  the  mother  of  such  child,  which  would  be  murder  if  it 
resulted  in  the   death  of  such  mother,  shall   be  deemed  manslaughter. 

[5743.]  Sec.  33.  Every  person  who  shall  administer  to  any  woman 
pregnant  with  a  quich  child,  any  medicine,  drug,  or  substance  what- 
ever, or  shall  use  or  employ  any  instrument,  or  other  means,  with 
intent  thereby  to  destroy  such  child,  unless  the  same  shall  have  been 
necessary  to  preserve  the  life  of  such  mother,  or  shall  have  been  advised 
by  two  physicians  to  be  necessary  for  such  purpose,  shall,  in  case  the 
death  of  such  child  or  of  such  mother  be  therely  produced,  be  deemed 
guilty  of  manslaughter. 

[5744.]  Sec.  34.  Every  person  who  shall  willfully  administer  to 
any  pregnant  woman  any  medicine,  drug,  substance,  or  thing  what- 
ever, or  shall  employ  any  instrument  or  means  whatever,  with  intent 
thereby  to  produce  the  miscarriage  of  any  such  woman,  unless  the 
same  shall  have  been  necessary  to  preserve  the  life  of  such  woman, 
or  shall  have  been  advised  by  two  physicians  to  be  necessary  for  that 
purpose,  shall,  upon  conviction,  be  punished  by  imprisonment  in  a 
county  jail  not  more  than  one  year,  or  by  a  fine  not  exceeding  five 
hundred  dollars,  or  by  both  such  fine  and  imprisonment. 

From  which  we  learn — 

That  what  constitutes  murder  in  case  of  the  death  of 
the  mother,  in  case  of  the  death  of  an  unborn  quick  child, 
by  willful  killing,  constitutes  manslaughter.  Should  death 
not  ensue  to  the  child  till  subsequent  to  its  birth,  in 
consequence  of  such  injuries,  we  suppose  it  would  then 
constitute  murder. 

And,  again :  The  destruction  of  a  quick  child,  by  at- 
tempts to  produce  abortion,  with  intent  to  destroy  such 
child,  like  the  death  of  the  mother  in  the  same  case,  con- 
stitutes manslaughter. 


Christian  on  Criminal  Abortions.  137 

In  the  first  case,  the  evil  intent  is  supposed  to  be 
airainst  the  mother,  and  hence  her  death  is  murder :  whilst 
the  death  of  the  child  being  accidental,  or  at  least  the 
design  being  not  against  the  child,  its  death  constitutes 
manslaughter.  In  the  second  case,  the  design  being  against 
the  child,  the  death  of  the  mother  is  accidental,  and  is 
only  manslaughter ;  and  the  death  of  the  child,  too,  is  man- 
slaughter, as  it  is  not  yet  regarded  as  a  living  being. 

But  how  is  the  destruction  of  a  child  not  yet  quick 
regarded,  and  what  the  penalty  ?  Why  there  is  no  pro- 
vision against  it,  and  no  penalty  except  such  as  is  imposed 
tipon  the  mere  aitemi^t  to  procure  miscarriage. 

And  what  is  the  penalty  for  attempting  to  procure 
miscarriage,  which  is  adjudged  sufficient,  also,  for  the  de- 
struction of  a  not  yet  quickened  foetus  ?  Imprisonment  in 
a  county  jail  not  more  than  one  year,  or  a  fine  not  exceed- 
ing five  hundred  dollars,  or  both — a  penalty  of  the  same 
grade,  and  almost  identical,  with  that  prescribed  for  simple 
assault  and  battery ;  a  penalty  less  severe  than  those  for 
^ny  oftenses  against  persons  which  are  directly  specified  in 
our  statutes,  and,  with  hardly  an  exception,  less  severe  than 
those  prescribed  for  any  offenses  against  property  of  which 
our  statutes  take  cognizance. 

Such,  then,  is  the  trivial  character  of  the  legal  enact- 
ments by  which  this  crime  is  designed  to  be  suppressed  — 
ubout  as  prophylactic  as  infinitesimal  globules  of  belladonna 
«;gainst  scarlatina — a  hawser  of  cotton  twine  to  bring  to  a 
check  the  headway  acquired  both  by  wind  and  tide.  And 
what  is  the  moral  force  of  such  enactments.^  Can  it  be 
anything  but  to  engender  too  lax  a  sentiment  in  regard  to 
the  criminality  of  the  offense,  to  create  the  opinion  that 
the  offense  consists,  not  in  the  successful  accomplishment, 
but  in  the  discovery  and  publicity  of  the  act.? 

On  what  principles  of  morality  or  facts  of  physiology 
is  this  distinction  made   as   regards  the   criminality  of  the 


138  The  Peninsular  and  Independent. 

destruction  of  a  not  yet  quickened  foetus?  Why  is  the 
destruction  of  a  five  months'  foetus  so  much  more  heinous 
an  offense  than  that  of  a  four  months'  foetus  ?  The  whole 
idea  is  a  relic  of  mediaeval  barbarism  and  ijrnorance  which 
should  be  eradicated  from  jurisprudence,  as  it  has  been  from 
physiological  science. 

If  there  is  to  be  a  distinction  in  criminality  based  upon 
development  of  the  foetus,  would  it  not  be  more  rational 
that  the  dividing  line  should  be  indicated  by  some  phe- 
nomenon more  unequivocally  indicative  of  independent  exist- 
ence, as  the  sound  of  the  foetal  heart,  indicating  an 
independent  circulation  ?  But  the  whole  thing  is  an 
implied  falsehood.  No  phenomenon  —  neither  motion,  foetal 
circulation,  nor  any  other  —  indicates  incipient  individual 
existence,  as  the  laws  falsely  intimate.  Physiology  only 
knows  existence  to  commence  with  conception.  But  if  it 
be  proper  or  politic  to  make  a  legal  distinction  in  regard 
to  the  destruction  of  the  foetus  at  different  periods,  let  not 
this  distinction  be  based  upon  false  conceptions  of  facts, 
and  thereby  inculcate  a  false  morality  on  the  subject.  It 
is  full  time  that  some  legal  barbarisms  should  be  banished 
where  many  gross  medical  ones  have  long  since  been  sen- 
tenced, to  add  an  interest  to  musty  tomes,  by  gratifying 
the  curious  student  of  ancient  knowledge. 

But,  as  we  have  before  intimated,  the  Medical  Profession 
has  a  duty  imposed  upon  it  in  relation  to  this  matter. 
The  means  of  prevention  are  more  effectively  in  the  power 
of  the  physician  than  in  that  of  the  executors  of  justice; 
or^  if  any  change  in  regard  to  legal  enactments  and  judicial 
executions,  respecting  this  matter,  it  requisite  or  advisable, 
the  influence  to  effect  that  must  come  mainly  through  the 
Medical  Profession,  who  alone  are  competent  witnesses  to 
the  frequency  of  the  crime,  and  to  the  necessity  of  means 
for  its  check.      His   duty  is,  as  we  have   said,  to  cause  to 


Christian  on  Criminal  Abortions,  139 

be   known  the   physical   penalties   which   must   be  paid,  of 
which  there  is  no  evasion. 

That  it  is  an  evil  of  some  importance,  too,  even  as 
regards  political  economy,  there  can  be  no  question ;  it  is 
one  destructive  of  life,  productive  of  impaired  health 
and  strength,  and  conducive  to  weakly  and  impaired  off- 
spring. How  much  of  an  evil,  in  this  light,  physicians 
only  know ;  and  they,  perhaps,  having  very  indefinite 
ideas  of  the  aggregate  in  any  large  community  for  certain 
periods. 

But  is  there  any  physician  of  any  considerable  practice 
who,  if  not  directly  applied  to  for  that  purpose,  does  not 
yet  frequentl  witness  the  baleful  effects  of  injudicious, 
and  perhaps  successful,  efforts  to  procure  abortion  ?  Cer- 
tainly within  the  writer's  own  experience,  in  a  limited 
practice  among  a  manufacturing  and  rural  population,  he 
has  had,  within  the  year,  several  open  applications,  evi- 
dently made  in  conscious  innocence,  to  have  abortion 
induced  ;  he  has  witnessed  several  severe  and  dangerous 
cases  of  illness  so  induced  ;  can  point  to  individuals 
whose  whole  life  is  one  of  continual  suffering  from  im- 
paired functions,  to  be  attributed  to  this  cause,  and  at 
least  one  death  may,  with  much  probability,  be  charged 
to  an  unsuccessful  attempt  of  this  nature.  How  much 
then  must  be  the  aggregate  of  the  experience  of  phy- 
cians  of  large   communities,  or   of  a   large  section ! 

Now,  as  an  array  of  figures  will  have  more  force  in  im- 
pressing a  truth  than  single  facts  now  and  then  reported, 
we  would  suggest  that,  inasmuch  as  it  is  desirable  that 
the  amount  of  prevalence  of  this  crime  should  be  known, 
and  the  nature  of  the  evils  resulting  from  it,  both  in  a 
moral,  political,  and  scientific  view,  that  the  members  of 
this  Society  be  requested  to  collate  facts  regarding  it, 
during  the  ensuing  year,  such  as  applications  made  for 
its    procurement,    cases    of    sickness   and    death    resulting 


140  Tke  Peninsaiar  and  Independent. 

from  efforts  of  the  kind,  character  of  physical  evils  re- 
sulting, convictions,  &c.,  and  that  these  statistics  be  for- 
w^arded  as  early  as  January  1st,  1860,  to  some  one  who 
shall  be  appointed  by  this  Society,  at  this  meeting,  to 
report  on  the  subject  of  Criminal  Abortions  at  the  next 
meeting.  We  are  confident  that  by  such  means,  if  faith- 
fully carried  out,  an  array  of  facts  could  be  displayed, 
surprising   even   to    the    Medical   Profession. 


AUT.  XII.— Selections  from  Surgical  \otes. 
By  Moses  Gunn,  M.  D. 


Case  I.     February  23d,  1859. — Mrs.  L ,  age  56  years, 

presented  herself,  with  a  large  tumor  upon  the  side  of  the 
face  and  neck,  extending  from  the  temple  to  within  two 
inches  of  the  clavicle,  and  projecting  outwards  about  four 
inches  beyond  the  angle  of  the  inferior  maxilla.  The  ear 
occupied  a  position  upon  the  posterior  surface  of  the  tu- 
mor. The  disease  was  of  thirty -two  years'  standing,  and 
its  progress  had  been  for  a  long  time  very  slow  ;  but  for 
the  last  few  months  its  advance  had  been  much  more 
rapid.  The  mass  was  distinctly  lobulated,  and  j)erceptibly, 
though  not  extensively,  movable  ;  it  was  also  clearly  un- 
blended with  adjacent  tissues.  The  integument  was  much 
attenuated,  but  unadherent  to  the  tumor. 

These  facts,  taken  in  connection  with  a  tolerable  pre- 
servation of  the  patient's  general  health,  led  to  the  diag- 
nosis of  the  benignant  nature  of  the  disease,  and  of  its 
probable  adipose  character.  The  prognosis  was  of  course 
favorable,  and  an  operation  was  advised  and   submitted  to. 

Operation :  An  elliptical  incision,  inclosing  a  small  por- 
tion of  the  integument  upon  the  summit  of  the  tumor,  and 
extending  from  the  upper   to   the   lower   extremity   of  the 


Gunn's  Selections  from  Surgical  Notes.  141 

mass,  was  made  down  to  the  substance  of  tlie  disease, 
It  was  now  found,  as  anticipated,  that  the  tumor  had  de- 
veloped for  itself  a  sort  of  capsule  in  the  areolar  tissue, 
from  which  it  could  be  readily  enunculated,  as  is  generally 
the  case  in  circumscribed  adipose  accumulations.  The  dis- 
ease, however,  was  observed  to  present  no  other  peculiar- 
ity of  this  substance. 

The  extirpation  of  the  mass  was  rapidly  accomplished, 
mainly  by  the  fingers  and  handle  of  the  scalpel.  The  fin- 
gers were  easily  carried  deep  into  the  neck  behind  the 
disease,  where  the  pulsation  of  the  carotids  could  be  dis- 
tinguished. A  few  bands,  only,  required  the  edge  of  the 
scalpel  for  their  separation,  and  these  were  upon  the  deep 
surface  of  the  mass.  Due  caution  was  observed  in  making 
these  sections..  The  parotid  gland  was  completely  absorbed, 
and  the  disease  occupied  its  place,  pushing  before  it  the 
branches  of  the  portio  dura  constituting  the  pes  anserinus. 
A  few  of  these  were  adherent  to  the  tumor,  and  were 
divided,  but  most  of  them  remained  intact,  and  could  be 
traced  in  the  wound  after  the  extirpation.  One  lobe  of 
the  diseased  mass  extended  deep  into  the  neck,  and  occu- 
pied a  portion  internal  to  the  styloid  process. 

Not  a  single  vessel  required  a  ligature.  The  wound 
healed  readily,  and  the  patient  made  a  good  recovery,  with 
only  slight  paralysis  of  the  muscles  of  the  face. 

Nature  of  the  disease  :  As  intimated  above,  the  diag- 
nosis as  to  the  probable  nature  of  the  disease  was  incorrect. 
It  was  not  an  adipose  growth  ;  but  presented  a  uniform 
grayish  flesh  color.  In  substance,  it  was  exceedingly  friable 
and  granular,  appearing  not  unlike  the  earlier  stages  of  en- 
cephaloid  disease.  Under  the  microscope,  its  heterologous 
character  was  distinctly  shown,  being  composed  mainly  of 
cells,  and  component  parts  of  cells  of  great  variety,  and 
conforming  to  Rokitansky's  description  of  one  variety  of 
encephaloid  disease. 


142  The,  Peninsular  and  Independent, 

The  above  case,  it  will  be  seen,  presents  features  of 
peculiar  interest.  The  slowness  of  the  growth,  the  un- 
blending  character  which  it  preserved  through  so  long  a 
period,  and  the  continued  health  of  the  patient,  are  symp- 
toms, the  union  of  which  would  point,  clearly  it  would 
seem,  to  the  non-malignancy  of  the  disease.  Its  structure, 
however,  both  as  it  appeared  to  the  naked  eye  and  under 
the  microscope,  as  plainly  point  to  an  opposite  quality. 
Should  the  disease  recur,  its  nature  will  then  be  clearly 
established  ;  but  its  anomalous  features  will  be  rendered 
only  more  distinctly  prominent  thereby.  Should  the  disease 
never  recur,  and  the  patient  attain  the  allotted  period  of 
man,  its  non-malignancy  would  then  be  undoubted  ;  yet  its 
structural  character  would  then  only  be  more  apparently 
inconsistent  with  received  doctrines  as  to  the  structure  of 
malignant  growths. 

Case  II.  December  5th,  1857. — Adam  Smith,  age  53  years, 
presented  himself,  with  a  flat  lobulated  tumor  covering  the 
greater  portion  of  the  dorsum  of  the  nose.  It  was  soft  and 
elastic,  and  had  existed  for  twelve  years.  It  had  ulcerated 
two  or  three  times  during  that  period,  discharging  (from 
his  description)  a  thin,  ill  -  conditioned  fluid,  which  could 
hardly  be  called  pus.  It  was  free  from  pain,  fixed,  and 
continually  increasing  in  size — latterly  with  greater  raj)idity. 
The  integument  was  healthy  except  at  the  cicatrix  of  the 
ulceration. 

Extirpation  was  advised,  and  performed  by  making  a 
crucial  incision  through  the  skin,  avoiding  the  cicatrix, 
dissecting  back  the  flaps  and  scraping,  rather  than  dissect- 
ing, the  diseased  mass  from  the  bony  and  cartilaginous  frame 
of  the  nose.  The  structure  of  the  disease  was  soft,  friable, 
and  granular,  and  closely  resembling  in  microscopic  appear- 
ance that  of  Case  I. 

The  flaps  were  adjusted,  and   united  partly  by  first  in- 


Gunn's  Selections  from  Surgical  Notes.  143 

tention,  but  mainly  by  granulation,  attended  by  free  and 
laudable  suppuration. 

There  has  been  no  return  of  the  disease  yet;  and  from 
the  appearance  of  the  patient,  there  seems  no  probability 
of  such  an  event. 

87  Shelby  Street,  May  18th,  1859. 


ART.  XIII,  — A  Criticism. 


By  J.  A.  Brown,  M.  D. 


In  the  Peninsular  and  Independent,  for  November,  1858, 
I  notice  a  very  well  -  written,  and  probably  well  -  intended, 
article,  from  the  pen  of  0.  C.  Gibbs,  M.  D.,  entitled  "  A 
Case  of  Obstruction  of  the  Boivels  relieved  by  Copious 
Injections  J   after  the   Failure   of  other  Means  J' 

On  looking  over  a  few  back  Nos.  of  the  Journal,  I  find 
that  this  Dr.  Gibbs  is  also  author  of  a  few  strictures  upon 
the  able  and  interesting  Eeport  of  the  talented  Dr.  S.  Du- 
Bois,  of  Michigan,   a  fine   scholar   and  ripe  student  of  his 
Profession,  upon  the  subject  of  '^  Rheumatism,"  read  before 
the    Michigan    State    Medical    Association    last    spring,    in 
which  he  (Dr.  G.)  seems  to  manifest   more   of  an   inclina- 
tion to  say  something  in  the  Journal  than  to  communicate 
any  new  fact  (notwithstanding  the  following  preface  to  his 
remarks  : — "  Its  reading  [viz.  that  of  the  Eeport]  has  sug- 
gested a  few  thoughts,  which  we  wish  to  express,  and  that 
too    in   no    spirit  of   criticism,  influenced  only  by  the  con- 
sciousness  that   it   is  every  man's  duty,  who  is  engaged  in 
the  noble  work  of  mitigating   pain   and    disease,  to  contri- 
bute his  mite  to  enhance  the  efficiency  of  his  art''),  as  he 
criticised   not   only  a  quotation  from   one  of  our   standard 
authorities,  which  was  just  as  much  open  to  criticism  be- 
fore  ever    it    appeared  in   that   Eeport  as  afterwards,  and 


144  The  Peninsular  and  Independent. 

which  we  think  he  must  previously  have  read,  but  suggest- 
ed no  new  idea,  either  in  the  pathology  or  treatment,  thai- 
his  effort  seemed  to  indicate  Dr.  DuBoiS  had  omitted,  oi 
mentioned  no  additional  agent,  except  cimicifuga,  which, 
of  course,  may  be  used  in  almost  any  case  where  a  diapho- 
retic is  desired.  This,  however,  being  a  digression  from  our 
subject  proper,  we  shall  leave  to  Dr,  DuBois. 

In  the  first  place,  then,  in  describing  his  case,  Dr.  G, 
says  : 

''^January   Ist,    1858.  —  I   was    called    to    see   Mrs.    R ,    aged 

about  55  years.  She  complained  of  severe  pain  in  the  bowels,  was 
vomiting  some,  the  pulse  was  quick,  tongue  furred,  bowels  tender 
on  pressure,  the  countenance  haggard  and  indicative  of  much  distress 
and  prostration.  I  suspected  strangulated  hernia,  but,  on  inquiry  and 
examination  this  supposition  proved  groundless.  Opium,  in  full  doses, 
combined  with  small  doses  of  calomel,  was  advised  internally,  and  hot 
fomentations   locally. 

"  Jamiary  2d.  —  The  patient  was  suffering  less  pain,  but  not 
otherwise  improved.  The  treatment  was  continued,  the  opium  in  du 
minished,    and   the   calomel   in   increased   doses. 

^'■January  Sd.  —  The  patient  was  no  better;  the  pulse  was  more 
frequent,  and  the  vomiting  still  continued.  Castor  oil  was  now  or- 
dered in  tablespoonful  doses,  to  be  repeated  every  hour  until  it  ope- 
rated ;  the  action  of  the  oil  to  be  aided  by  injections  of  infusion  of 
senna." 

The  bowels  now  becoming  "  bloated  and  tympanitic," 
the  external  application  of  hot  oil  of  turpentine  was 
adopted,  with  little  or  no  other  change  in  the  treatment 
until  after  the  seventh  day,  except  an  increase  of  the 
mercury  to  gr.  5,  with  an  evident  aggravation  of  all  the 
symptoms,  as  he  himself  states,  and  no  evacuation  from 
the  bowels  ;  for  the  simple  reason,  evidently,  that  up  to 
this  time  no  efficient  and  reliable  cathartic  agent  had 
been  administered — at  least,  in  anything  like  efficient  doses, 
especially   with   such   an   object   in   view. 

Now,    does   this    appear   at   all   like   rational   treatment 
for   obstruction    of    the    bowels ;    viz.    The    use    of   solid 


Brown. — A  Criticism.  145 

opium   for   three    or   four    days    together,   loith    little    or 
nothing   else;    and,    indeed,    nothing   else   in   anything   like 
sufficient    quantities    to    produce    catharsis  ?      Indeed,    it 
would   seem   from   the   treatment,    that    the   case   was   not 
regarded,    whatever    else    it   might   have   been   thought   to 
be,    as    one    of    obstruction ;    as    it    appears    no   attempt 
was    ever   was   made    to    clear   the    primce  vice,    until,    at 
least,    the   third   or   fourth   day,    when   castor  oil  was   pre- 
scribed  in   doses    of  only   a   tablespoonful,    at   intervals   of 
an   hour,    in   which    quantities   it   would   be   very  likely  to 
be   digested   in    the   stomach,  with   no   cathartic   effect,  in- 
stead   of    administering    it    in   a  full   dose    at   once    (viz. 
two   or   three   large   spoonfuls)  ;    and  nothing   more  potent 
than   this   resorted   to    until   the   seventh   day,   and   indeed 
not   at   all   for    this  purpose,  unless   it  was   the  eaii  chaud 
(warm    water),    pumped   in   from   below. 

We   do    not    know   whether   it    is   correct   or   not,    but 
it   seems    to   us,    from   his  own   statement    of  the   case,  to 
be    the   only  reasonable   inference,    that  Dr.  G.,    mistaking, 
or   at   least   not   appreciating,  the   true   nature  of  the   dif- 
ficulty,   commenced   his    operations   rather   in    the   dark,  or 
empirically,    without    reference    to    any   definite   or   specific 
object   or   end,    and   contented   himself  with   battling,  with 
an    energy   and   perseverance   in    the   use   of    the   measures 
adopted  that,  had  they  been  wisely  or  difierently  directed, 
would   have   done   him   vastly   more   credit    against,    or   in 
endeavoring   to   remove,   what   would    seem    to    be    rather 
the   result,    or   symptoms,  of  a   more   serious   disease   than 
the   disease   itself      Indeed,    looking   at   the    symptoms    as 
detailed  by  himself — viz.    ^^ severe   pain  in   the  bowels   and 
tenderness  on  pressure,  vomiting,  quick  pulse,  furred  tongue, 
countenance   haggard   and   indicative  of  great   distress,  ob- 
stinate  constipation,   and   prostration," — what  tyro  in  me- 
dicine,   with   any   degree   of  diagnostic   skill   and   discrimi- 
nation,   would  not  readily   have    predicted   the   real   diffi- 

Vol.  II.- K. 


146  The  Penuisular  and  Lidependent. 

culty,  viz.  Inflammation  of  tlie  LoweLs  (peritoneal  coat)^ 
to  which  the^  above  phenomena  all  pointed  with  almost 
an  infalible  certainty  ?  and  yet  Dr.  G.  tells  us,  "  he 
first  suspected  strangulated  hernia,"  until  after  an  exa* 
mination  and  inquiry,  without  having  had  his  attention 
directed  to  any  such  local  affair,  as  is  always  done  in 
those  cases  by  the  patients  themselves,  usually  stating 
'Hhey  are  burst,  or  have  a  breech,"  &c.  What,  we  ask, 
in  the  name  of  reason,  could  it  have  been  but  perito- 
nitis ?  and,  hence,  how  perfectly  irrelevant  the  following ; 
which  we  repeat :  ^^  I  first  suspected  strangulated  hernia"!! 
Again ;  Dr.  G.,  evidently  looking  upon  the  case  aa 
nearly,    or   quite   hopeless,    says  : 

*'  I  now  explained  to  the  friends  that  it  was  possible  that  a 
copious  injection  might  overcome  the  obstruction^  and  afford  relief; 
this,  I  said,  will  occasion  much  pain,  but  we  certainly  ought  not  to 
let  the  patient  die  without  making  at  least  one  more  efrort  to  afford 
relief  Of  the  many  present,  I  selected  two  women  of  nerve  and 
decision  to  carry  out  my  directions.  With  a  pump,  I  ordered  thera 
to  inject  tepid  water  into  the  bowels,  so  long  as  they  could"  prevail 
upon  the  patient  to  endure  it.  This  they  did,  and  returned  to  me 
soon,  informing  me  that  they  had  injected  only  about  a  pint.  The^ 
patient's  sufferings,  they  said,  wore  extreme.  Less  had  been  accom- 
plished  than   I   had   expected. 

"I  now  took  the  pump  myself,  closed  the  door  against  specta- 
tors, and  commenced  injecting,  entreating  the  patient  to  endure  to 
the  utmost,  as  this  was  her  only  hope.  This  she  did,  for  a  time^ 
but  soon  her  shrieks  and  groans  became  heart-rending.  Her  husband 
and  son  now  rushed  into  the  room,  and  commanded  me  to  desist 
from  further  attempts  to  relieve  the  patient ;  which  I  did  only  after 
at  least  two  quarts  had  been  injected.  The  friends  evidently  looked 
upon   me   as   a   personification   of  brutality."     &c. 

It  is  true,  after  this  the  bowels  moved,  but  the  real 
disease  evidently  remained  undisturbed  or  unchecked ;  and, 
as  a  consequence,  "  the  patient  was  not  destined  to  re- 
cover." "  She  died,  seemingly/'  says  he,  "  from  an  in- 
ability to  rally  from  the  extreme  prostration."  Then  in 
the  next  sentence,    again,   he   continues  :     "  Peritoneal  in- 


Brown. — A  Criticism.  147 

flammation  was,  doubtless,  the  cause  of  death'';  without, 
however,  having  adopted  a  treatment  scarcely,  if  any, 
more  appropriate,  or  rational,  for  this,  than  for  the 
imagined    "obstruction''    during   the   first   seven   days. 

Now,  is  there  not  great  incongruity  just  here  ?  If 
the  "  patient  died  from  an  inability  to  rally  from  the 
extreme  prostration"  caused  by  obstruction,  could  "perito- 
neal inflammation  have  been  the  cause  of  death "  ?  and 
vice  versa  ?  Again,  that  the  case  was  considered  only  as 
one  of  obstruction  to  the  end  of  his  efforts  (though  by 
no  means  in  our  estimation  treated  as  such  in  the  be- 
ginning), apart  from  the  title  of  his  article,  is  evident 
from  the  last  measure  adopted,  the  importance  of  which 
he  urged  upon  the  patient  and  friends  as  a  dernier  resort, 
without  even  intimating  the  presence  of  peritonitis ;  and 
whether  the  practice  was  inhuman,  as  is  more  than  in- 
timated the  friends  seemed  to  think,  or  not,  I  shall  not 
attempt  to  decide ;  but  will  venture  the  assertion  only, 
That  however  admissible  and  appropriate,  it  neither  reached 
nor  overcame  the  real  and,  as  it  turned  out,  fatal 
malady. 

Now,  in  conclusion,  I  would  say,  in  language  very 
nearly  like  that  which  closes  the  article  criticised,  and 
with  due  deference  to  its  author,  —  That  had  the  case 
been  clearly  understood,  and  copious  blood-letting  resorted 
to  in  the  very  out  -  set,  and  perhaps  repeated ;  then  a 
brisk,  reliable  cathartic  given,  followed  by  his  "  calomel 
and  opium"  (which  were  by  no  means  inappropriate,  had 
they  been  given  with  direct  reference  to  the  inflammation 
instead  of  obstruction),  with  the  topical  use  of  "hot  oil 
of  turpentine  to  the  abdomen,"  or,  what  would  have  been 
better,  large  linseed  cataplasms  saturated  freelj^  with  the 
oleum  terahinthence,  "  the  result,"  it  seems  to  us,  "  might 
have   been   diflerent." 

Kankakee   City,    III,    May  1st,  1855. 


148 


TIte  Pe7iinsalar  tuid  Indtptndtni. 


ART.  XIV.  — Meteorological  Register  for  Month  of  April,  1859. 

By  L.  S.  IIoRTON,  House  Physician  to  U.  S.  .Marine  Hospital. 


Altitude  of  Barometer  above  the  level  of  tlie  sea,  597  feet.     Latitude   4''®''4'N  •   and 
Longitude.  82"  58' W.  of  Gicenwicli.  >     -- 


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iibli^gra^Irial  |lu0rK 


FIVE  ESSAYS.  By  John  Kearsley  Mitchell,  M.  D.,  Late  Professor 
of  Practice  of  Medicine  in  Jefferson  Medical  College  of  Philadel- 
phia; Member  of  the  Academy  of  Natural  Sciences  of  Philadel- 
phia; Fellow  of  the  Philadelphia  College  of  Physicians,  &c.  Edited 
by  S.  Weih  Mitchell,  M.  D.,  Lecturer  on  Physiology  in  the 
Philadelphia  Association  for  Medical  Instruction.  Philadelphia:  J. 
B,   Lippincott   &    Co.     1859. 

The  collection  and  publication  of  these  Essays  is  the  result, 
undoubtedly,  of  a  laudable  desire,  arising  from  affection, 
to  perpetuate  the  memory  of  the  author.  We  make  this 
statement,  however,  with  no  disposition  to  disparage  the 
merits  of  the  book,  or  of  the  justly  celebrated  teacher  and 
practitioner  from  whose  pen  its  contents  emanated.  With 
a  single  exception,  the  editor  informs  us,  these  papers  had 
all  been  previously  given  to  the  public.  That  exception  is 
the  Essay  upon  Animal  Magnetism  —  a  subject,  which, 
though  badly  named,  is  full  of  interest,  and  in  the  consi- 
deration of  which,  if  our  author  is  not  fully  right,  he  forms 
no  exception  to  the  general  rule ;  indeed,  the  one  who 
should  be  so,  would  prove  the  exception.  The  other  papers 
are  not  yet  forgotten.  May  the  memory  of  the  author 
never  become  so  !  Gr. 


REPORT  ON  THE  NERVOUS  SYSTEM  IN  FEBRILE  DISEASES, 
AND  THE  CLASSIFICATION  OF  FEVERS  BY  THE  NERVOUS 
SYSTEM.  By  Henry  Frazek  Campbell,  A.  M.,  M.  D.,  Professor 
of  Anatomy  in  the  Medical  College  of  Georgia.  Extracted  from 
the  Transactions  of  the  American  Medical  Association.  Philadel- 
phia:   Collins.    1858. 

We    are   indebted  to  the  politeness  of  the    author  for  the 
above    named    pamphlet,    consisting    of   172    pages.       The 


150  The  Peninsular  and  Independent. 

readers  of  the  Independent^  and  of  the  consolidated  journal, 
know  full  well  our  views  upon  the  subject  of  Dr.  Camp- 
bell's Prize  Essay ;  these  views  are  closely  interwoven  with, 
and  distinctly  characterize,  the  subject  considered  in  the 
above  Keport.  For  these  views  we  sincerely  respect  and 
honor  the  author,  and  are  proud  to  be  conscious  of  the 
fact  they  were  clearly  taught  by  Dr.  Allen  in  the  Uni- 
versity of  Michigan  during  the  first  year  of  its  existence. 
Dr.  Campbell  is  following  up  the  subject  with  most  laud- 
able zeal,  and  with  untiring  industry,  as  evinced  in  the 
Keport  under  consideration.  He  is  upon  the  right  track, 
and  his  clear  conceptions  contend  most  favorably  with  the 
chaotic  results  which  arise  from  giving  full  credence  to  all 
of  Brown-Sequard's  manifold  and  multiform  experiments, 
and  the  adoption  of  all  his  conclusions.  G. 

THE  MICROSCOPIST'S  COMPANION;  A  Popular  Manual  of  Micros, 
copy.  By  Joun  King,  M.  D.  Cincinnati,  0. :  Robert  Clark  &  Co. 
Publishers. 

An  illustrated  directory  for  the  benefit  of  the  Microscopist 
—  showing  him  what  constitutes  the  principles  involved  in 
the  construction  of  the  Microscope,  the  methods  of  using  it, 
a  complete  descriptive  j^rice-list  and  catalogue  of  all  the 
various  instruments  made  by  American  manufacturers  of 
Microscopes,  together  with  a  glossary  of  terms,  and  a  com- 
pilation of  useful  matter  for  those  who  are  beginners  in 
the  use  of  the  Microscope. 

We  should  judge  it  to  be  of  value  to  students. 

F.  S. 


iMt0rial  §ti}uximtnl. 


The  Late  Medical  Teachers'  Convention. 

Since  the  organization  of  the  American  Medical  Asso- 
ciation, it  has  been  continually  exerting  itself  in  behalf 
of  medical  education.  The  meetings  of  the  dissociation 
have  been  mainly  made  up  of  representatives  from  the 
body  of  the  Profession,  changing  to  a  great  extent  from 
year  to  year.  This  persistent  effort,  therefore,  can  not  be 
without  cause ;  it  means  that  the  Profession  is  fully 
aware  of  the  fact  that  Medical  Education  is  not  what 
it  should  be ;  that  men  are  yearly  graduated  in  large 
numbers,  who,  at  the  time  of  their  graduation,  are  en- 
tirely unfit  to  assume  the  responsibilities  of  the  medical 
man  ;  that  human  life  is  thus  trifled  with ;  and  that, 
as  a  profession,  it  has  duties   to   perform  in   the  premises. 

Without  legislative  authority,  the  action  of  the  Asso- 
ciation has  exerted  only  a  moral  influence  over  the  schools, 
and  this  influence  has  not  been  as  powerful  as  could  be 
wished.  The  reason  of  this  lies  in  the  fact  that  medical 
schools  are  generally  commercial  rather  than  educational 
institutions.  Profit  to  the  Professors  is  the  main  con- 
sideration in  their  organization  and  existence.  Such  being 
the  case,  schools  are  slow  to  inaugurate  any  course  which 
will  have  a  tendency  to  diminish  the  yearly  number  of 
students.  The  present  avenue  to  the  privileges  of  the 
Profession   is   broad,  and  the   gate   is   wide,  and  many  are 


152  The  Peninsular  and  Independent. 

they  which  go  in  thereat.  A  narrower  gate,  and  a  more 
rugged  way,  would  lessen  the  numbers  of  those  who  find 
it ;  and  would  also  diminish  the  golden  stream  which 
flows  into  the  pockets  of  those  who  pilot  the  passage. 
It  is  not  strange,  then,  that  the  most  prosperous  schools 
are  backward  in  adopting  reformatory  measures.  We  are 
not  surprised,  therefore,  that,  at  the  late  Teachers'  Con- 
vention, Philadelphia  and  New  York  were  not  represented. 
We  are  not  surprised  that  those  schools  have  virtually 
said,  We  want  no  improvement ;  we  are  not  anxious  to 
make  better  students ;  we  are  not  anxious  to  elevate 
the  standard  of  education  ;  we  are  not  desirous  of  alter- 
ing the  present  condition  of  educational  affairs,  which, 
as  is  well  known,  is  such  that  students  who  fear  re- 
jection at  other  schools,  or  who  have  actually  received 
such  treatment,  repair  without  hesitation  to  us,  and  re- 
ceive their  degrees.  On  the  contrary,  we  desire  that  this 
impression  should  continue  to  prevail,  in  order  that  we 
may  still  reap  the  golden  fruits  thereof  We  repeat,  that 
we  are  not  surprised  at  this  course  of  the  schools  of 
the  two  great  medical  centres  of  the  Union.  We  confess, 
however,  that  we  were  surprised  that  the  University  of 
Nashville,  whose  representatives  were  jDresent,  did  not 
participate  in  the  Convention.  We  were  surprised  because 
we  had  regarded  that  school  as  an  advocate  of  improve- 
ment in  educational  matters  ;  and  we  are  sincere  in  our 
reluctance  to  class  her  with  the  Philadelphia  and  New 
York   schools. 

But,  although  the  Convention  did  not  accomplish  any- 
thing immediately  tangible,  it  was  not  without  its  bene- 
ficial influence.  It  appointed  a  committee  to  confer  with 
the  different  schools  in  the  Union  upon  the  subject  under 
consideration ;  and  adjourned,  to  meet  in  New  Haven  on 
the  day  previous  to  the  next  annual  meeting  of  Asso- 
ciation.     The   Association   also   appointed   a  committee  of 


Editorial  Department.  153: 

conference  with  the  committee  of  the  Teachers'  Conven- 
tion ;  and  we  are  confident  in  the  hope  that  this  com- 
mittee will  also  actively  exert  itself  during  the  interval, 
and  meet  with  the  Teachers'  Convention  at  its  next 
assembling.  We  would  also  express  the  hope  that  the 
Teachers'  Convention  will  prove  a  permanent  organization, 
and   that   it   will  be   productive   of  much   good. 

We   shall  recur  to  this  subject   again.  G. 

The  Meeting  at  Louisville. 

Another  (the  Twelfth)  Meeting  of  the  National  Asso- 
ciation has  just  taken  j)lace. 

In  one  respect,  at  least,  it  was  the  most  important 
meeting  which  has  convened  since  the  organization  of  the 
Association.  Entirely  without  legislative  authority,  the 
meetings  of  the  Association  have  hitherto  been  productive 
of  good,  principally  in  two  ways.  First,  in  the  production 
of  a  few  remarkably  good  Essays  and  Eeports ;  second,  in 
bringing  together  men  from  widely  -  separated  portions  of 
the  country,  and,  not  only  by  contact  in  convention,  but  by 
social  intercourse,  breaking  down  those  "middle  walls  of 
partition"  which  naturally  spring  from  location,  and  which 
thrive  upon  sectional  prejudice.  The  latter  we  regard  as 
certainly  not  second  to  the  first  in  professional  profit  and 
general  good ;  and  while  we  hail  with  genuine  joy  the 
adoption  of  the  plan  by  which  Eeports  and  Papers  are  to 
be  submitted  to  discussion  and  criticism  before  appropriate 
sections  of  the  Association,  believing  that  thereby  greater 
interest  will  attach  to  the  proceedings  and  greater  good 
result,  we  confess  that  we  have  a  real  love  for,  and  a  faith 
in,  the  social  intercourse  which  attends  these  meetings. 

In  this  connection,  too,  we  would  vindicate  the  Profes- 
sion in  reference  to  the  charge  of  quarrelsome  proclivities. 
However    justly   this   may  be    chargeable   upon    individual 


154  Tlie  Peninsular  and  Independent. 

members,  in  the  species  of  rivalry  which  naturally  occurs 
between  neighboring  practitioners,  the  great  body  of  the 
Profession  is  certainly  not  bellicose  in  character.  Com- 
pare the  meetings  of  the  National  Medical  Association 
with  those  of  the  National  Association  for  the  Advance- 
ment of  Science,  and  the  intercourse  of  the  doctors  ap- 
j)ears  in  the  comparison  like  billings  and  cooings  of  turtle 
doves.  But,  without  the  advantage  of  'such  comparison, 
the  meetings  of  the  Association  have  ever  been  charac- 
terized by  discussions  at  once  dignified  and  courteous. 
Its  members  are  remarkly  free  from  jealousy,  and  but 
for  those  jealousies  whicn  arise  from  the  representation 
of  rival  colleges,  the  word  would  hardly  have  a  meaning 
in   the   convention. 

The  meeting  at  Louisville,  as  to  number  in  attendance^ 
was  reasonably  good,  though  not  large.  The  Keports  of 
the  Committees  were  generally  wanting  ;  and  the  conven- 
tion expressed  its  dissatisfaction  at  the  delinquencies,  by 
refusing,  in  several  instances,  to  continue  the  committee. 
Several  volunteer  communications  were  received,  and  were 
read  by  title,  or  an  abstract  was  given.  Another  year, 
this,  we  trust,  will  all  be  different.  Keports  and  com- 
,  munications  will  be  read  at  length,  and  discussed  in  sec- 
tions of  the  Association.  These  discussions  will,  we  doubt 
not,  2:)rove  at  once  interesting  and  profitable ;  and,  by 
criticising  the  Reports  and  Essays,  the  value  of  the 
published    Transactions   will   be   enhanced. 

The  reception  of  the  Association  by  the  Profession 
and  citizens  of  Louisville  was  indicative  of  warm-hearted 
hospitality.  The  houses  of  several  of  the  citizens  (and 
among  them  that  of  Prentice  of  editorial  celebrity),  as 
well  as  those  of  the  Profession,  were  thrown  upon  to 
the  Association.  Princely  homes  and  cordial  hearts  greeted 
the  advent  and  sojourn  of  the  members  of  our  Profession 
with    a    tribute    of    respect.       Amid    the    hospitalities    of 


Editorial  Department.  155 

Louisville,  one  could  easily  forget  the  toils  and  perplexi- 
ties of  practical  medical  life,  and  rejoice,  for  once,  in  the 
title  of  Doctor.  Gr. 


Oar  Indigenous  Plants. 

The  American  Pharmaceutical  Association,  soliciting  the 
co-operation  of  the  Agricultural  Bureau  of  the  Patent 
Office  in  its  endeavors  to  amplify  and  develop  our  medical 
resources,  appointed  a  committee,  at  its  last  Session,  to  con- 
fer with  that  Bureau,  in  order  to  mutually  further  these 
objects  ;  and  we  gladly  notice  that  the  opportunities  and 
power  possessed  by  the  Government  have  been  recently  di- 
rected to  seeking  information,  though  the  Indian  Agents, 
concerning  these  indigenous  medicinal  plants  in  domestic 
use  among  the  various  Indian  tribes  in  our  territory.  The 
following  is  the  substance  of  a  circular  recently  sent  to  the 
ladian  Agents  by  the  Secretary  of  the  Interior: 

1.  What  medical  plants  are  used  by  the  different  Indian  tribes 
in   the   vicinity   of  the    Agency  ? 

2.  What  are  the  medical  virtues  ascribed  by  the  Indians  to 
them  —  whether  emetic,  cathartic,  diuretic,  diaphoretic,  expectorant, 
anthelmintic,  stimulant,  narcotic,  tonic,  astringent,  or  antispasmodic; 
and  the  diseases  said  to  be  cured  or  alleviated  by  the  respective 
plants  ? 

3.  In   what   latitude   are   they   to   be   found  ? 

4.  In   what   quantities   can   they   be   obtained? 

5.  How   near   to   navigable   streams    can   they   be   gathered? 

6.  What   facilities    can   be   had   for   sending   them   to   market? 
This   information   is   to   be   forwarded   to   the   Indian   Bureau. 

The  replies  elicited  from  these  queries  are  to  be  em- 
bodied in  a  Keport  to  be  made  to  the  American  Pharma- 
ceutical Association  at  its  next  meeting — 'One  which,  we 
trust,  will   form  a  valuable   feature  in  its  proceedings. 

F.  S. 


156  The  Peninsular  and  Independent. 

EDITORIAL    CORRESPO      DENCE. 


Steamship  Persia  —  Off  the  Coast  of  Ireland,  ) 
April  23d,  1859.  \ 

Bear  Readers  of  the  Peninsular  and  Independent : 

In  the  April  No.  of  the  Journal^  the  Editors  intimated  that 
as  one  of  their  number  was  to  be  abroad  for  several  of  the 
following  months,  he  would  furnish,  from  time  to  time,  com- 
munications presenting  some  of  the  results  of  his  observations. 
That  task  is  commenced  here,  and  now ;  and  in  order  that  you 
may  be  addressed  in  these  letters  in  the  most  direct  and  fa- 
miliar personal  style  —  a  style  which  it  is  presumed  will  be 
most  acceptable,  at  least  to  those  who  have  sustained  the  re- 
lation of  listeners  (as  not  a  few  of  our  readers  have)  to  the 
attempted  instructions  of  the  writer  —  the  first  person  singular 
will   be  adopted. 

I  left  Detroit  on  the  evening  of  the  6th  inst.  Witliout 
the  occurrence  of  any  event  worthy  of  record,  reached  Albany 
on  the  P.M.  of  the  next  day. 

Called  on  Dr.  A.  March,  the  venerable  and  still  enthusiastic 
Professor  of  Surgery  in  Albany  Medical  College.  The  school 
in  which  Prof  March  is,  perhaps,  the  most  prominent  attraction, 
has,  until  this  season,  held  two  Sessions  or  Courses  of  Lectures 
annually,  reckoning  each  as  a  full  Course,  and  granting  degrees 
at  the  close  of  the  Spring  Term  as  well  as  that  of  the  Fall  Term, 
which  closed  a  short  time  before  the  other  commenced.  By  at- 
tending these  two  Courses  in  succession,  a  student  who  could 
satisfy  the  Faculty  as  to  time  of  study  and  other  qualifications, 
might  graduate  within  eight  months  from  the  period  of  hearing 
his  first  lecture.  This  course  has  been  a  subject  of  complaint 
on  the  part  of  many  members  of  the  Profession,  for  some  time 
past;  and  the  expression  becoming  so  general  —  the  subject 
having  been  more  than  once  discussed  at  the  meetings  of  the 
American  Medical  Association — in  deference,  as  is  understood, 
to  that  sentiment,  the  second,  or  Spring  Course,  of  Lectures 
has  been  discontinued. 

The  voice  of  the  Profession,  through  the  Association,  is  thus 
being  heard  and  regarded;  and  if  that  Association  is  true  to 
itself  and  the  Profession — is  moderate,  consistent,  and  perse- 
vering in  its  expressions  and  acts,  the  time  is  not  distant 
when  no   School   claiming  regularity  and  respectability  will  be 


Editorial  Department.  157 

found  resisting  its  reasonable  requirements.  Time  is  required  for 
the  accomplishment  of  all  things  —  much  time  for  all  great  im- 
provements upon  established  customs  of  large  numbers,  and  con- 
trary to  the  opinion  of  some  high  in  the  Profession.  I  believe 
the  American  Medical  Association  has  already  accomplished  much 
good  in  relation  to  Medical  Education — as  much  as  could  rea- 
sonably have  been  expected  from  it  in  the  time  of  its  operations, 
and  that  greater  achievements  are  still  to  be  realised  by  this 
bodv. 

With  regard  to  the  general  condition  of  the  Albany  Medical 
College,  I  learned  that  the  number  of  students  in  attendance  is 
not  increasing,  and  that  one  of  the  Faculty  (Prof.  Hann),  who 
iias  very  acceptably  occupied  the  Chair  of  Physiology  and  Patho- 
ology,  has  resigned.  His  place  not  having  been  supplied,  ano- 
ther member  of  the  Faculty,  in  addition  to  his  regular  labors, 
will  deliver  the  Course  on  these  important  subjects. 

As  I  did  not  sail  until  the  13th  inst.  I  had  several  days  in 
Xew  York  City.  Since  the  unfortunate  "  Whitney  affair  " — un- 
fortunate for  all  parties  who  have  been  in  any  way  connected 
with  it  —  nothing  of  special  professional  interest  has  occurred  in 
this  great   metropolis  of  our  country. 

The  Schools  have  closed  their  sessions,  though  limited  courses 
of  lectures  are  being  delivered  to  such  new  students  as  remain 
in  the  city,  and  some  of  the  College  Clinics  are  still  kept  in 
operation.  The  instructions  in  Bellevue  Hospital,  instead  of 
being  systematized  and  rendered  more  specific  and  thorough,  now 
that  students  are  relieved  from  their  six  lectures  per  day  at  the 
colleges,  and  therefore  have  time  to  attend  to  them,  I  am  in- 
formed have  become  less  frequent  and  full  than  during  the  ses- 
sions of  the  colleges,  when  they  could  not  have  had  time  from 
their  other  studies  to  give  them  proper  attention.  This  is  a  state 
of  things  which  should  not  exist. 

I  do  not  designate  Bellevue  with  a  view  of  representing  this 
great  Institution  in  a  more  unfavorable  light  than  others,  here  or 
elsewhere  —  on  the  contrary,  I  believe  more  is  being  done  for 
clinical  instruction  in  this  than  in  any  other  institution  in  the 
country ;  but  I  wish  simply  to  show  that  nowhere  among  us  is 
this  most  important  part  of  medical  teaching  placed  upon  the 
proper  footing. 

There  can  be  no  doubt  that  the  great  need  of  Medical  Edu- 


158  The  Peninsular  and  Independent. 

cation  at  the  present  time,  is  a  system  of  thorough,  practical, 
Clinical  Instruction ;  and  this  can  only  be  carried  into  effect 
when  special  schools  of  Clinical  Teaching  are  established,  and 
when  students  are  in  attendance  upon  such  schools  and  such 
teaching  at  a  time  when  not  fully  occupied  with  elementary 
and  didactic  instruction  in  the  colleges.  Systematic  clinical 
instruction  should  be  chiefly  conducted  when  the  colleges 
are  not  in  session,  and  always  to  students  who  have  attended 
a  full  course  of  didactic  elementary  medical  teaching.  Such 
schools,  in  a  great  city,  would  in  no  way  interfere  with  the 
established  colleges,  but  would  rather  be  a  complement  to  them 
— together  completing  what  neither  could  do  alone  ;  and  besides 
they  would  attract  students  to  those  cities  in  wliich  they  were 
established,  and  retain  them  there  to  complete  their  medical 
pupilage. 

I  scarcely  need  add  that  New  York,  of  all  other  places 
on  our  continent,  is  the  best  ( not  but  that  others  may  be 
very  good)  for  such  schools  ,and  such  instruction.  Here,  ma- 
terials are  more  abundant,  of  greater  variety,  and  more  acces- 
sible than  anywhere  else.  It  is,  and  ever  will  be,  the  great 
Commercial  Emporium  of  the  New  World,  and  may  be  made 
the  great  Medical  Emporium  as  well.  This,  however,  can  only 
be  done  by  the  establishment,  under  proper  direction,  of  cli- 
nical schools  and  clinical  teaching,  such  as  has  been  suggested. 
Other  and  smaller  places  are  equally,  if  not  more,  capable 
of  producing  men  qualified  for  primary  and  elementary  me- 
dical teaching ;  but  no  place  furnishes  such  a  field  as  New 
York  for  teaching  clinical  medicine  and  surgery.  In  teaching 
elementary  and  didactic  medicine,  other  places  may  compete 
with  her,  and  outstrip  her,  but,  under  proper  management, 
in  clinical  instruction  it  is  impossible.  Some  members  of  the 
Profession  in  New  York,  capable  of  giving  them  realization, 
are  becoming  impressed  with  these  ideas,  and  the  time  may 
not  be  distant  when  their  importance  shall  be  more  fully 
appreciated  and   their   realization   entered   upon. 

As  already  stated,  our  good  ship  Persia  left  New  York 
on  the  1 3th  inst.  The  largest  steamer  of  the  Cunard,  or 
British  and  North  American,  line,  being  nearly  400  feet  in 
length,  she  is  filled  to  her  utmost  capacity  with  passengers, 
all   being  regarded   as   first-class  —  paying  8130  each.     Not   se- 


Editorial  Department.  159 

curing  my  passage  long  beforehand,  as  most  did,  I  was  among 
the  very  last  provided  for,  and  was  assigned  a  berth  in  the 
state-room  of  the  "  Doctor "  of  the  ship,  being  told  that  I 
would  find  it  very  comfortable  and  pleasant,  and  at  the  same 
time  assured  that  it  was  the  only  placej  left.  This  latter  state- 
ment decided  the  matter,  as  I  was  desirous  of  leaving  as  soon 
as  possible,  and  no  other  suitable  vessel  was  to  sail  under 
about   two   weeks. 

A  regular]  dissertation  on  "Life  at  Sea"  is,  I  believe,  per- 
petrated by  everybody  who  crosses  the  ocean,  and  writes 
letters  back ;  but  I  shall  save  you  this  infliction  —  (it  could 
scarcely  be  anything  else,  after  the  many  you  must  all  have 
read)  - —  and  especially  as  my  present  experience  would  not 
allow  me  to  write  in  a  very  pleasant  strain.  I  shall  confine 
myself  to  a  few  observations  upon  points  having  a  professional 
bearing. 

On  entering  the  state-room  assigned  me,  which  was  situ- 
ated on  deck,  and  so  far  having  a  promise  of  pure  air,  my 
olfiictories,  fortunately  not  very  acute,  were  assailed  with  the 
mingled  odors  of  medicines,  whiskey,  and  tobacco — the  latter 
decidedly  predominating;  and,  in  addition  to  these,  another 
odor  highly  composite  in  its  character,  and  very  peculiar, 
pervading  the  whole  vessel,  finding  its  greatest  concentration 
in  the  lower  cabins  and  state-rooms,  was  not  absent  from  this. 
This  was  by  no  means  an  agreeable  introduction  to  sea -life, 
and  was  a  pre-disposing  cause  to  that  general  condition  which 
causes  the  "  gorge  to  rise,"  and  which,  from  the  moment  I 
put    my  foot   on   the  planks,  I  felt   sure   would   come. 

Before  we  had  entirely  left  the  harbor,  swells  from  the 
ocean  began  to  roll  in,  not  very  perceptible  to  the  eye,  espe- 
cially w^hen  situated  so  far  above  the  waters  as  on  deck,  but 
still  they  were  sufiicient  to  cause  the  immense  structure  to 
undulate  —  to  cause  its  bow  and  stern  alternately  to  rise  and 
sink  with  a  sIoav  and  graceful,  yet  to  the  landsman  like  my- 
self,  an   unsettling   motion. 

As  we  got  fairly  to  sea,  pointed  our  bowsprit  to  the  east, 
and  after  halting  a  moment  to  discharge  our  pilot,  the  im- 
mense engine  a  perfect  marvel  of  mechanism,  commenced  its 
steady  and  untiring  movements ;  and,  like  the  seat  of  life  in 
the  human  frame,   pulsates  on,    and,   to  the  present    moment. 


160  The  Peninsular  and  Independent. 

as  we  now  approach  oin*  liarbor,  lias  not  coased  for  an  in- 
stant, bearing  us  steadily  onward  against  wind  and  wave  ; 
and  the  ship,  almost  as  constantly  as  she  has  plowed  througl) 
the  sea,  has  risen  and  fallen  as  the  great  swells  of  the  rest- 
less  ocean  have  swept   past   in   their  mighty   power. 

I  have  fiomewliere  heard  tlie  suggestion,  that  ships  would 
be  made  so  large  that  they  would  be  uninfluenced  by  the 
waves,  and  that  all  inconvenience  aiising  from  motion  would 
be  avoided.  My  present  observation  has  dispelled  this  illusion. 
It  is  true  that  by  the  size  of  a  vessel  the  motion  produced 
by  ordinary  waves  may  be  unperceived,  but  the  grand  ocean- 
swells,  measuring  such  distances  from  the  summit  of  one  to 
that  of  the  next,  as  they  do,  will  cause  the  largest  ship  is 
is  practicable  to  build  and  manage,  to  rock.  When  the  sea 
was  far  from  its  angriest  moods,  one  standing  near  the  stern 
of  our  sliij)  would  see  the  bow  so  pointing  towards  the  depths 
as  to  indicate  that  the  whole  vessel  would  plunge  beneath 
the  surface,  yet  the  next  moment  it  would  rise  again,  lifting 
itself  on  high  —  thus  the  great  ship  was  borne  like  a  feather 
over  the   rippling   bosom   of  a  stream. 

But  the  eifect  of  this  motion  upon  the  human  organism  is  tht* 
subject    most   interesting   to   a   medical    man. 

You  have  all  heard  and  read  of  sea-sickness,  though  not 
much  is  said  on  the  subject  in  medical  books.  Indeed,  little 
is  known  about  it  except  the  prominent  phenomena ;  and  they 
can  be  described  in  few  words.  Nausea  and  vomiting  are 
the  more  marked  symptoms,  but  they  by  no  means  consti- 
tute the  whole  of  tlic  mor1)id  phenomena  caused  by  a  vessel's 
motion.  There  are  others  wliich,  if  not  as  marked  and  de- 
monstrative, are  of  equal  ini])ortance.  The  primary  morbid 
impression  of  the  motion  is  doubtless  made  on  the  nervous 
system.  The  efl:ect  upon  the  stomach — the  vomiting  and  the 
persistent  nausea  which  accompanies  it — are  the  secondary,  and 
not  the  only  secondary,  effects  which  result.  The  secretions 
are  all  changed — perverted.  The  tongue  becomes  furred,  and 
a  most  unpleasant  taste  is  in  the  mouth.  The  actions  of  the 
intestines  are  disturbed.  There  may  be  at  first  an  increased 
peristaltic  action,  causing  uneasiness,  and  a  tendency  to  diarrhoea; 
but  decided  diarrhoea  is  seldom  developed — the  peristaltic  ac- 
tion   being  rather  reversed,   its  normal   character  at   any  rate 


Editorial  Department,  161 

suspended,  and  constipation  follows.  Though  feverishness,  as 
marked  by  heat  and  increase  of  pulse,  is  seldom  produced, 
yet  the  urine  is  loaded,  the  flesh  often  rapidly  wastes  away, 
and  the  general  perversion  of  secretions  and  other  organic 
actions  shows  a  condition  resembling  the  general  derangement 
of  a  fever.  The  mental  functions  are  not  unfrequently  dis- 
turbed in  much  the  same  manner  as  during  some  fevers,  and 
the   nights   are  restless   and   dreamy   in   the   same   way. 

My  experience  and  observations  during  this  voyage,  have 
enlarged  my  notions  of  the  character  and  importance  of  sea- 
sickness. It  is  a  much  more  general  disease  than  I  had  sup- 
posed. Its  bad  results,  it  is  true,  are  seldom  permanent  or  dan- 
gerous. It  is,  indeed,  popularly  regarded  as  a  beneficial  process, 
and  therefore  seldom  excites  either  alarm  or  sympathy.  It  is 
nevertheless  a  decided  disease,  and  has  more  than  once  proved 
fatal  in  constitutions  already  debilitated;  and  though,  by  the 
changes  it  effects  in  the  system,  it  may  operate  as  a  remedy  in 
one  laboring  under  previous  disorder,  as  any  other  disease  may 
supplant  a  previously  existing  one,  yet  it  is  essentially  a  morbid 
process,  and  no  person  in  previous  good  health  can  reasonably 
expect  to  be  benefited  by  it;  unless  as  a  severe  chastising  it 
works  a  moral  reform — which  I  fear  it  seldom  does. 

As  to  the  medical  treatment  of  sea -sickness  I  have  learned 
nothing  of  much  value.  I  have  been  sick — oh,  how  uncomforta- 
bly sick! — most  of  the  way.  I  took  one  dose,  by  the  advice  of 
the  ship's  "  Doctor,"  of  tiiict.  ginger,  aqua  ammonia,  and  chloric 
ether;  but  threw  it  up  in  a  few  minutes  after,  and  have  taken 
nothing  since  except  a  bottle  of  native  Seltzer  water  after  I  began 
to  get  better,  w^hieli  was  most  grateful  to  the  stomach,  and  gently 
removed  a  symptom  so  common,  before  referred  to.  At  this  pre- 
sent writing,  I  am  happy  to  say,  I  am  nearly  myself  again,  though 
the  thoughts  of  the  past,  mingled  with  some  of  the  odors  of  the 
present,  stirred  into  activity  by  an  occasional  extra  motion  of  the 
ship,  bring  back  some  of  those  same  sensations  I  w^ould  gladly 
forget. 

From  all  I  can  learn,  my  present  impression  of  medical  treat- 
ment is  that  it  is  of  little  avail.  Chloroform  has  been  recommend- 
ed by  high  authority,  but  the  testimony  I  get,  received  from  the 
experience  of  others,  is,  that  it  as  frequently  seems  to  do  harm  as 
good,  and  in  any  case  can  only  be  palliative  and  temporary.    The 

Vol.  II.  -  L. 


162  Tlie  Peninsular  and  Independent. 

best  preventive  coarse  is  to  take  food  moderately  and  regularly 
according  to  previous  habits,  exercise  on  deck  as  much  as  possible ; 
but  when  the  attack  has  actually  supervened,  the  recupibent  pos- 
ture must  be  taken,  and  kept  for  the  most  part,  though  occasional 
changes  to  the  sitting  or  erect  position,  even  at  the  expense  of  in- 
creased sickness  and  vomiting  at  the  time,  will  be  found  useful. 
After  taking  food,  the  patient  should,  if  inclined  to  vomit,  lie  per- 
fectly still  until  it  has  passed  out  of  the  stomach.  This,  for  sev- 
eral days  was  the  only  manner  in  which  I  could  retain  any 
food,  and  thus  prevent  the  greatest  prostration.  As  soon  as 
he  is  able  to  rise  without  vomiting,  the  patient  should  appear 
on  deck. 

Besides  the  motion  of  the  vessel,  the  special  causes  con- 
tributing to  sickness  on  ship-board,  are  impure  air  arising  from 
the  difficulty  of  eftecting  ventilation  beneath  the  surface  of 
the  water,  and  the  smallness  of  apartments  and  their  crowded 
condition:  and  on  these  steamers,  the  abominable  practice  of 
eating  five  times  a  day,  drinking  all  sorts  of  spirits,  wines, 
and  beers,    and  smoking  innumerable  segars. 

The  compensation  for  medical  services  on  board  these  ves- 
sels by  the  Company,  I  am  told,  is  small,  and  therefore  the 
best  class  of  men  can  not  be  expected  to  accept  of  the  situa- 
tions. Either  young  men,  before  having  established  a  reputa- 
tion or  secured  a  practice,  or  older  men  of  inferior  capacity 
or  character  must  be  taken.  In  some  cases,  I  am  told  that 
both  youth  and  inferiority  mark  the  men  that  serve  as  rej)- 
resentatives  of  our  Profession  on  these  instruments  of  commu- 
nication between  the  Old  and  the  New  World;  and  I  am  sorry 
to  believe  that  these  positions  are  not  those  in  which  the  in- 
cumbents are  most  likely  to  improve  in  general  or  profession- 
al character.  They  have  not  sufficient  duties  to  occupy  their 
time — their  state-rooms  are  small  and  uncomfortable  —  unsuit- 
ed  to  study  —  they  are  constantly  mingling  with  passengers 
who  have  little  else  than  eating,  drinking,  smoking,  and  gam- 
ing to  occupy  their  attention  for  the  voyage,  and  thus  bad 
habits  are  apt  to  be  formed.  These  conclusions  are  not  drawn 
from^  observations  on  this  ship  alone,  but  from  all  I  can  learn 
on  the  subject. 

The   "Doctor"    of  the   Persia,   with   whom   I   am    rooming 
for  the  voyage,  is  a  gentleman   of  the  "  Irish   persuasion,"  and 


Editorial  Department.  163 

•of  the  strictest  of  the  sect,  as  is  evinced  in  his  accent,  man- 
ners, and  particularly  in  his  face.  I  am  under  much  obliga- 
tion to  his  politeness  to  me;  for,  among  other  kind  things, 
<on  learning  that  tobacco  smoke  was  not  in  accordance  with 
my  tastes,  he  desisted  entirely  from  smoking  in  his  room, 
confining  his  indulgence,  which  was  nearly  constant  however, 
to  the  deck,  the  smoking-room,  and  other  places  about  the  ship. 
Liverpool  is  announced  as  not  far  distant;  the  bustle  pre 
paratory  to  landing  has  commenced;  and  I  must  bring  this 
long  letter  to  a  close. 

In  writing  only  respecting  subjects  having  a  bearing  upon 
the  subject  of  Medicine,  I  fear  I  have  given  too  unpleasant 
a  picture  of  the  voyage.  ^N'otwithstanding  my  almost  constant 
sickness,  there  has  been  much  of  pleasing  interest  to  me  since 
leaving  New  York.  I  have  formed  several  acquaintances  of 
a  very  agreeable,  and  I  hope  of  a  lasting  and  profitable  char- 
acter; and  the  perfect  order  and  regularity  of  the  ship's 
management,  and  the  feeling  of  perfect  safety  inspired  by  all 
its  appointments — not  to  mention  the  beauty,  the  grandeur, 
the  sublimity  of  the  illimitable  ocean — have  left  impressions 
worthy   of  being  cherished. 

When  you  shall  hear  from  me  again,  I  hope  it  will  be 
respecting  medical  men  and  medical  matters  on  this  side  of 
the   great  waters   which  now  separate   us. 

Yours   Truly,  A.  B.  P. 

Medical  Chronicle  (Moutreal). 

We  are  sincerely  regretful  to  see,  in  tbe  closing  ISTo.  of 
the  Sixtli  Volume  of  this  valuable  Monthly,  an  announce- 
ment of  its  discontinuance.  Like  a  majority  of  the  medi- 
cal journals  it  has  only  succeeded  in  paying  the  actual 
publishing  expenses  ;  and  now  that  a  new  postage  law  im- 
poses a  further  tax  upon  the  enterprize,  the  proprietors  are 
forced  to  abandon  it.  We  can  not  forbear  remarking,  that 
it  is  but  an  ill  commentary  upon  the  Canadian  Profession 
that  it  fails  to  support  its  only  medical  journal. 

AVe  part  with  the  Chrcniclej  and  its  accomplished  edi- 
tors, with   great   reluctance,  and  witb   the  hope  that   they 


164  The  Peninsular  and  Independent, 

will  be   yet   induced  to  renew  their  efforts  in  the  editorial 
section  of  the  great  medical  field.  G. 


Resignation. 

It  is  announced,  in  the  last  No.  of  the  Medical  News, 
that  Prof  L.  P.  Yandell,  long  identified  with  that  old 
and  meritorious  institution,  the  University  of  Louisville,  has 
resigned  his  professorial  chair. 

We  trust  that  the  name  Yandell  will  still  continue 
to  shed  its  lustre  over  the  University,  even  though  a  change 
of  initials  should  occur.  G. 

Erratum. 

On  page  150,  twelfth  line  from  top,  read  ^^contrasf 
for  "contend." 

Pre  -  Payment  of  tliis  Journal. 

Of  the  April  No.  of  this  journal  we  distributed,  through 
the  mail,  nearly  two  thousand  copies ;  of  the  May  No. 
we  sent  onhj  to  those  who  remitted  for  the  year  previous 
to  the  issue  of  that  No.,  and  to  those  who  had  j)aid  in 
full   for   Vol.    I. 

In  future,  while  we  propose  to  issue  a  large  edition 
each  month  above  our  regular  subscription  list,  we  shall 
not  send  it  regularly,  except  to  those  who  pay  in  ad- 
vance, reserving  to  ourselves  the  right  to  distribute  the 
balance  of  each  edition  among  such  non  -  subscribers  as 
we   please. 

It  will  be  seen  that  all  who  desire  a  full  set  for  the 
year  must  remit  to  us  in  advance,  for  we  shall  be  unable 
to   supply   back   Nos.   beyond   a   limited   extent. 

HIGBY   &   STEAKNS. 


Editorial  Department.  165 


CORRESPONDETfCE. 


THE  AMERICAN  MEDICAL  ASSOCIATION. 

The  last  meeting  of  this  Association  convened  at  Louisville,  Ky., 
the  city  of  the  glorious  State  of  Kentucky,  in  which  are  found  men 
of  science,  eminent  in  the  profession  of  medicine,  who  extended  the 
hospitalities  of  private  homes,  and  the  genial  welcome  of  the  whole 
city  to  the  members  of  our  profession ;  and  last,  not  least^  heautiful 
woman^  adorns  the  festivities  given  in  their  beautiful  city,  and  welcomes 
the  representative  of  scientific  medicine  to  their  homes,  adorned  with 
all  that  art,  science,  and  fancy  could  desire,  to  while  away  the  tedium 
of  the  hours,  which  otherwise  would  hang  as  a  dead  weight  upon  the 
stranger,  away  from  his  home  and  his  professional  avocations.  Thanks 
to  the  hospitality  and  kindness  of  the  Profession  of  Louisville,  and  for 
the  hospitalities  of  the  city ! 

But  the  American  Medical  Association  is  a  proper  subject  for  some 
reflections. 

Having  accomplished  much  good  for  the  Profession,  and  for  science, 
shall  it  go  on  its  career  of  usefulness  and  honor,  and  be  still  the  pride 
of  every  honest,  intelh'gcnt,  and  scientific  medical  man  in  the  Union. 
If  so,  it  must  be  composed  of  working  men,  and  moi^e  of  them.  The 
impression  of  a  member  who  had  never  attended  one  of  its  sessions, 
and  who  had  rather  an  exalted  opinion,  previously,  of  its  objects  and 
character,  has  not  been  improved  very  much  by  attending  its  late  ses- 
sion ;  and  there  are  several  reasons  why  new  members  expressed  them- 
selves disappointed  in  visiting  the  Association,  and  seeing  the  mode  of 
conducting  its  business. 

In  reference  to  the  observance  of  ^j>a7'Zi*«?72(S7ito?^2/  order,  there  is  just 
cause  of  criticism.  Though  a  semblance  of  observance  of  such  order, 
it  is  not  regarded  as  reaching  even  near  to  a  point  of  perfection ;  and 
a  criticism  in  one  of  the  daily  papers  of  Louisville  had  this  opinion: 
"That  the  members  of  the  Association  talked  much  about  order,  and 
yet  violated  the  rules  of  order,  and  discussed  questions  of  constitutional 
origin  (which  had  reference  to  the  organic  character  of  the  Association) 
with  as  much  gravity  as  if  they  were  legislating  for  the  world."  And, 
again,  in  reference  to  reports  and  reporters,  a  remark  of  this  kind 
was  common;  That,  much  of  the  interest  of  the  Association  was  lost, 
l)y  the  failure  to  report  of  those  committees  appointed,  upon  the  various 
topics  of  investigation.  So  it  seems  to  those  outside  of  the  Profession, 
that  there  is  too  much  want  of  energy  to  labor  in  the  cause  of  science 
in  too  many  members  of  this  highly  distinguished  body  of  men.  Men 
of  the  Profession  in  the  old  country  have  eulogized  the  character  of 
this  body,  and  shall  we  fold  our  arms  and  see  its  reputation  suffer 
because  individually  we  do  not  labor  ?    Never !     This  Association  does 


166  The  Peninsular  and  Independent. 

indeed  legislate  for  the  Profession,  but  let  its  sessions  possess  that 
dignity  and  gravity  becoming  its  high  position.  The  fault  is  not  with 
the  officers  but  with  its  members,  and  they  should  labor  to  harmonize 
the  conflicting  interests  of  the  Profession  in  the  various  parts  of  the 
country.  The  great  feature  of  strength  which  gives  the  National  Medi- 
cal Association  its  vitality  and  power,  is  bringing  together  the  medical 
men  of  the  country,  breaking  down  and  rooting  out  those  prejudices 
which  grow  out  of  varied  interest,  and  forming  ties  of  friendship  and 
good  feeling  which  will  leaven  the  whole  mass  into  a  combination  of 
power  and  strength  not  equaled  on  earth  among  medical  men.  But 
the  evidence,  drawn  from  its  late  session,  is  not  favorable  for  long  con- 
tinued vitality  or  strength  ;  in  fact  it  gave  vnmistalable  signs  of 
premature  age  and  decay.  And  one  or  more  worlcing  members  gave  his 
prognosis  upon  the  time  of  its  existence.  (I  hope  his  prognostications 
are  not  true.) 

Then  let  every  member  come  up  to  the  work,  and  labor  manfully 
and  w^hen  called  upon  for  a  Report  do  not  "beg  an  extension  of  time'* 
as  has  been  done,  and  I  fear  too  often,  merely  to  display  their  names 
as  reporters  upon  the  pages  of  the  Transactions. 

One  other  observation  I  shall  make,  and  leave  the  members  to 
ponder  it  well.  It  has  been  said  that  the  practice  of  the  Medical  Pro- 
fession requires  the  individual  possession,  by  its  members,  of  a  clear 
and  vigorous  mind,  a  practised  eye  and  steady  hand.  But  I  think  too 
many  of  the  members  of  the  American  Medical  Association  indulge  in 
libations,  and  particularly  on  the  occasions  of  these  meetings,  too  freely 
to  possess  the  requisites  here  mentioned,  and  who  discredit  themselves, 
the  Profession,  and  the  Association.  Ponder  well,  young  men  of  the 
Medical  Profession,  your  future  history,  if  you  sacrifice  to  Bacchus  as 
freely  as  some  of  you  have  done  while  legislating  for  the  Profession, 
and  while  you  are  filling  positions  of  honor  and  influence !  Do  you 
think  your  places  will  sustain  you  in  this  course  ?  On  the  other  hand 
you  must  sustain  honor,  character,  and  professional  reputation ;  if  you 
do  not,  you  will  fall  from  j^our  high  positions.  A  medical  man,  last  of 
all  men  in  the  world,  should  not  drink  anything  stronger  than  cold 
water.  At  the  bed  side,  his  vigorous  mind  should  not  be  beclouded 
with  the  paralyzing  influence  of  drink;  in  the  teacher'' s  cTiair^  his  mind 
should  grasp  his  subject,  and  make  it  plain  and  easy ;  in  the  associated 
capacity  of  our  National  Body,  let  reason,  judgment,  and  wisdom  sway 
their  sceptre ;  and  I  trust  as  a  Profession  we  will  accumulate  strength 
and  energy,  and  become  as  a  light  to  the  world,  which  can  not  be  hid^ 

H. 

EiCHiroND,  Ind. 


thtttl^i  ^xiith$,  Jibstrarts,  &t. 


TRANSLATIONS  from  FOREIGN  JOURNALS  for  the  PENINSULAR  AND  INDEPENDENT.. 


By  0.  D.  Palmer,  M.  D. 


(From  Gazette  Hebdomadaire  de  Medicine  et  de  Chirurgie,  Feb.  25,  1859.) 

IMPROVEMENTS  MADE  TO  THE  OPERATION  FOR  VESICO  -  VAGINAL  FIS- 
TULA BY  AMERICAN  SURGERY.  — Third  Article. 

Dr.  Marion  Sims'  Method. — No  one,  I  hope,  will  suspect  my  imparti- 
ality when  I  speak  of  foreign  surgeons,  from  whom  I  am,  and  ever 
expect  to  be,  separated  by  thousands  of  miles,  and  yet  I  can  not,  how- 
ever, conceal  the  embarrassment  I  experience,  in  appreciating  the  labors 
of  Dr.  Marion  Sims.  This  author  has,  in  fact,  written  two  articles  on 
Vesico- Vaginal  Fistulas — the  first  in  1852,  couched  in  the  most  suitable 
scientific  forms  ;  the  other  in  1858,  which  is  nothing  more  than  a  lengthy 
apology  for  metallic  sutures,  and  for  him,  at  the  same  time,  whom  he 
believes  to  be  the  inventor,  that  is  to  say,  for  Marion  Sims,  himself. 
It  is  with  as  much  astonishment  as  of  pain,  that  we  see  this  distin- 
guished practitioner  claim  for  himself,  in  the  most  exclusive  manner,  the 
operative  means  and  manoeuvres  which  have  belonged,  for  long  years,  to 
the  public  domain.  His  illusions  of  priority  are  otherwise  so  much  the 
more  injurious,  as  he  employs,  in  order  to  justify  them,  the  most  bitter 
words,  and  assertions  the  most  extravagant. 

A  singular  thing  is,  that,  in  1852,  Dr.  Sims  contented  himself  in 
making  public  the  method  which,  at  that  epoch,  he  had  adopted.  In 
1858,  he  insists,  particularly,  on  his  pretended  discoveries,  so  that  we 
must  seek  for  the  history  of  the  author's  first  attempts,  in  a  pamphlet 
published  six  years  after  the  dogmatic  publication  of  these  attempts. 
Then  in  1858,  Dr.  Sims  has  modified  his  method  of  1852,  so  that  we 
can  not  examine  his  labors  in  chronological  order. 

If  the  first  paper  of  Dr.  Sims  was  received  with  merited  favor  by 
his  countrymen,  the  second,  on  the  contrary,  has  called  forth,  in  both 
the  American  and  the  English  press,  criticisms  more  or  less  severe; 
which  we  shall  not  follow  farther  than  is  necessary  to  a  scientific  dis- 
cussion—  that  is,  in  pruning  them  of  personalities.      I  demand    pardon 


168  The  Peninsular  and  Lidej^endent. 

of  the  reader  for  this  long  preamble,  but  if  we  profess  the  greatest  re- 
spect for  persons,  we  esteem  the  rights  of  Science  and  of  History  as  not  less 
sacred.  Above  all  individual  pretensions  are  placed  the  irrecusable  au- 
thority of  facts,  of  dates,  and  of  records — veritable  archives  of  intellect- 
ual and  scientific  property.  It  is  not  unnecessary  to  recall  this  principle 
at  the  dehut  of  a  delicate  criticism  like  the  one  we  are  about  to  under- 
take. 

The  author,  himself,  teaches  us  that  in  1845  he  conceived  the  idea 
of  remedying  the  Fistula  V^sico -Vaginalis,  that  he  had  hitherto  be- 
lieved beyond  the  resources  of  Art.  By  accident,  at  that  time,  whilst 
attending  a  lady  affected  with  retroversio  nteri,  he  had  her  placed  upon 
her  knees  and  elbows,  the  pelvis  more  elevated  than  the  chest,  in  order 
to  reduce  the  displacement,  which  was  recent.  This  was  the  occasion 
of  his  first  discovery;  in  effect  he  makes  it  appear,  that,  whilst  in  this 
attitude,  the  uterus  elevated  itself  from  the  vulva,  and  that  the  supe- 
rior part  of  the  vagina  was  spontaneou-^l}''  dilated,  the  whole  produced 
by  the  pressure  of  the  atmosphere  on  ihe  internal  walls  of  the  vagina, 
and  enlarging  it  in  all  its  diameters.  Struck  by  this  fact,  Dr.  Sims  was 
anxious  to  examine,  in  the  attitude  above  described,  a  woman  affected 
with  Vesico -Vaginal  Fistula,  who  had  just  then  been  confided  to  his 
care.  lie  states  that  the  fistulous  opening  became  perfectly  accessible 
to  view,  and  also  that  he,  at  that  time,  had  a  glimpse  of  the  possibility 
of  a  happy  operation. 

An  appeal  made  to  his  neighboring  colleagues  enabled  Dr.  Sims  to 
assemble  seven  or  eight  cases  of  Fistulas,  abandoned  as  incurable.  The 
silversmiths,  blacksmiths,  dentists,  and  manuficturers  of  instruments, 
were  put  under  contribution  to  fashion  a  rough  surgical  arsenal,  and  at 
length  the  first  operation  was  performed  on  the  11th  of  Januar}-",  1846. 
It  is  not  inutile  to  say  that  Dr.  Sims  announced  having  read  all  the 
authors  he  could  find,  on  this  subject,  even  before  his  Jirst  operation, 
without  having  found  anything  but  ohscurity  and  confanon. 

The  case  was  very  simple,  the  fistula  being  transver.^1  and  situated 
at  the  base  of  the  vesica,  an  inch  and  a  quarter  broad.  There  was 
abundant  tissue.  The  opposition  was  very  exact,  and  still  he  was  un- 
successful. It  is  true  the  orifice  was  so  much  reduced  that  it  would 
not  admit  a  No.  4  bougie. 

Encouraged  by  this  first  result  he  repeated  the  operation  on  another 
woman,  but  without  success.  Then  he  made  new  and  various  trials, 
till  each  patient  had  submitted  to  numerous  operations,  but  all  in  vain. 
His  hopes  were  almost  annihilated,  and  he  was  advised  to  give  over  his 
attempts,  but  he  had  com'municated  his  enthusiasm  to  his  patients,  who, 
endowed  with  indomitable  courage,  insisted  upon  his  repeatedly  renewing 
his  trials. 

During  three  years  Dr.  Sims  made  use  of  what  he  called  damp 
sutures,  operated   by  a  complicated  machinery,  a  design  of  which   may 


Selected  Articles^  Abstracts^  c&c.  169 

be  found  on  page  56  of  his  second  pamphlet.  His  ill  success  appearing 
to  him  to  be  connected  with  this  apparatus,  he  abandoned  it.  He  then 
called  to  mind  that  when  a  boy  he  used  to  hammer  shots,  and  close 
them  around  his  fishing-line  with  his  teeth,  the  better  to  make  it  sink. 
This  reminiscence  came  to  him  on  the  night  of  the  14th  November,  1846! 
Thence  a  new  means  came  to  light  for  fixing  the  threads  of  the  suture, 
new  essays  were  made,  but  ever  fruitless.  The  clamps  intended  to  se- 
cure the  threads  were  too  voluminous.  They  were  at  first  diminished, 
and  then  afterwards  re -placed  with  bars  of  lead.  In  spite  of  all  these 
modifications,  failure  was  constant.  This  was  then  attributed  to  the 
catheter,  and  it  was  newly  fashioned.  At  this  epoch,  according  to  Dr. 
Sims,  the  mechanical  part  of  the  operation  was  perfect.  Why,  then,  did 
he  not  succeed?  The  idea  came  to  him  to  substitute  for  the  silk  thread 
leaden  wire,  for  making  ligatures,  and  often  used  by  Mettaueu  and  Dif- 
FENBAcn,  and  the  innocuousness  of  which  had  been  demonstrated  by 
Levert.  Two  cases  of  Vesico  -  Vaginal  Fistulas,  and  one  of  Recto-Vagi- 
nal Fistula,  were  treated  by  this  means,  and  which,  hrqyj^ih/,  says  the 
author,  misca-rried  like  the  others.  He  then  thought  of  gold,  of  silver, 
and  of  platina;  and  ordered  to  be  made  by  a  jeweler,  silver  wire  the  size 
of  ordinary  sewing  thread,  with  which  he  operated  on  the  21st  of  June,. 
1840. 

Case. — It  was  upon  a  young  negress,  who  had  never  murmured  at  the 
preceding  failures.  She  was  placed  upon  the  table  for  the  thirtieth 
time.  The  leaden  clamps,  the  silver  wire,  and  the  perforated  shot,  were 
put  in  use.  In  all  the  preceding  operations,  the  urethra,  at  the  end  of 
two  or  three  days,  became  red  and  painful,  the  urine  surcharged  with  a 
thick  tenacious  mucus,  evident  signs  of  inflammation,  which  prevented  the 
immediate  union.  In  this  case,  the  urine  remained  perfectly  limpid,  and 
on  the  eighth  day  the  parts  were  completely  healed.  The  suture  ap- 
paratus remained  in  place,  as  on  the  day  of  its  application ;  the  leaden 
cross-bars  that  supported  the  ligatures  were  merely  a  little  imbedded 
in  the  mucous  membrane  of  the  vagina. 

The  problem  was  at  length   solved,  and   but  a  few  days  after,  and' 
all  the    persons  on   whom   he   had   experimented  so   long  a  time   were 
cured. 

A  severe  disease  induced  Dr.  Sims  to  publish  to  the  world  his  first 
paper,  though  he  could  have  willingly  elucidated  still  further  some 
points.  Having  sent  it  to  Philadelphia,  the  memoir  was  published  in 
the  ''American  Journal  of  the  Medical  Sciences^''^  page  59,  of  the  Jan- 
uary No.  for  1852. 

It  is  this  work  that  we  are  now  about  to  examine.     It  is  true  it  was 
not  necessary  to  report  the  preceding  matter  ;  I  have  thought,  however 
it  would  be  interesting  to    know   to   what   anguish  —  to  what  pre -occu- 
pations—  an  ingenious  and    tenacious    spirit  is  submitted   that   seeks    to 
attain  its  aim  without  being  lieterred  by  obstacles  or  misfortunes.      We 


IVO  The  Peninsular  and  Independent. 

resume  briefly  the  recital  of  Dr.  Sims'  perplexities ;  they  at  least  fill  up 
fifteen  pages.  We  have  pruned  them  of  all  digressions  and  all  the  pas- 
sages in  which  "Providence,"  "Almighty  God,"  "Divine  Mission,"  &c., 
appear  here  to  play  a  very  inopportune  part.  At  the  very  first,  in  read- 
ing these  pages,  one  is  incited  to  raillery,  and  to  laugh  at  the  folly ; 
then,  he  can  not  hinder  himself  from  a  kind  of  admiration  for  the  double 
perseverance  of  the  operator,  and  for  those  operated  upon,  especially. 
We  can  not  doubt  that  during  four  years  the  cure  of  Finiulaa  Vesico- 
Vaginales,  had  been,  with  Dr.  Sims,  a  species  of  humanitary  monomania, 
very  rare  among  Surgeons,  and  which,  also,  is  not  destitute  of  greatness. 
Tlierc  is,  however,  a  useful  lesson  to  be  drawn  from  all  this.  Dr.  Sim3 
has  tortured  his  brain  for  four  years,  in  order  to  invent  methods,  which 
were  a  long  time  since  published,  and  which  had,  in  1849,  produced 
more  than  one  success.  Two  or  three  months  would  have  been  abundant- 
ly sufficient,  to  have  read  the  works  published  on  this  matter,  and  to 
have  realized  some  success;  for  in  18-iO,  I  repeat  it,  a  goodly  number 
of  Fistnhis  Vesico-  Vaginales  had  been  healed   by  the  suture. 

Accident,  perseverance,  ingenuity,  reasonning,  may  certainly  had  to 
great  therepeutic  discoveries,  but  the  surest  route  still  is  to  appeal  to 
the  experience  of  others,  ard  it  is  this  that  makes  the  sound  erudition 
the  way  that  still  conducts  the  most  certainly  to  progress. 

We  will  only  add  one  remark :  That  without  indicating  their  num- 
ber. Dr.  Sims  declares,  implicitly,  that  previous  to  his  first  success  ho 
had  operated  many  times,  since  one  patient  alone  come  to  the  amphi- 
theatre for  the  thirtieth  time.  In  supposing  that  our  surgeon  had  made 
the  fiftieth  trial,  we  can  not  well  explain  how  he  has  been  so  unfortu- 
nate, and,  at  the  same  time  so  persevering;  for  at  the  time  even  when 
manual  operation  was  verj^  defective,  some  one  succeeded  always,  from 
time  to  time ;  for  example,  Lallemand,  Dieffenbacii,  &c. 

Meiliod  of  Dr.  Sims  in  1852. — After  some  generalties  on  the  causes, 
diagnostics,  prognostics,  anatomical  varieties  of  Vesico- Vaginal  Fistula, 
followed  b}''  a  historical  summar}^  in  which  the  frequent  want  of  success 
of  the  suture  is  recounted,  the  author  claims,  by  right,  the  priority, — 

1st.  For  the  discovery  of  a  method  of  exploring  the  vagina  which 
permits  the  seeing  easily,  and  operating  with  facility  ; 

2d.  For  a  new  suture  apparatus  which  remains  imbedded  in  the 
tissue  for  an  indefinite  period  of  time  without  cutting  through  like  the  silk 
thread  ; 

3d.  For  the  invention  of  a  ''''  self -retaining''''  speculum  easily  sup- 
ported by  the  patient  during  treatment. 

We  will  also  divide,  on  our  part,  the  examination  of  this  method  into 
three  parts. 

1st.  By  the  eii:doration  of  tlie  Vagina. — We  have  seen  above  in  what 
this  innovation  consisted,  and  how  Dr.  Sims  arrived  at  the  discovery.  Here 
are   more   details.     The   patient   is  placed   on   a   table,   two   and  a  half 


Selected  Articles^  Abstracts^  dbc.  l'7l 

to  four  feet  high ;  she  is  to  support  herself  on  her  knees  and  elbows* 
the  haunches  elevated,  the  head  and  shoulders  depressed,  the  knees 
six  or  eight  inches  separated,  the  thighs  flexed  at  right  angles.  The 
dress,  any  way  capable  of  exerting  a  pressure  on  the  abdominal  paries, 
is  suppressed.  From  each  side,  an  assistant  places  one  hand  in  the 
fold  of  the  breech,  in  such  a  manner  as  to  be  able  to  touch  the 
lahia  majora  with  the  extremity  of  the  fingers.  If  the  nates  are  then 
drawn  upwards  and  outwards,  the  vulvar  orifice  is  opened,  the  p.elvic 
and  abdominal  viscera  gravitate  toward  the  epigastric  region,  and  the 
atmospheric  pressure  is  exerted  on  the  walls  of  the  vagina  (according  to 
Dr.  Sims  at  the  rate  of  fourteen  pounds  to  the  square  inch),  displaying 
this  canal  in  its  greatest  extent, — the  view  then  attains  very  easily 
to   the  fistula  to   the   os    tincw,  &c. 

In  order  to  facilitate  the  exploration  of  the  parts,  the  aid  situated 
on  the  right  introduces  into  the  vagina  the  level' -  speculum^  and  ele- 
vates the  cloison  recto -vaginal;  the  cavity  becomes  then  as  easily  to 
see   as   the   back   part  of  the  throat   when   the   mouth   is  widely  open. 

One  word  now,  in  regard  to  the  speculum  —  an  instrument  so 
precious   that   I    commend   with  all   my   heart. 

[Here  follows  a  description  of  the  speculum  —  a  translation  of  which, 
without   figuring,   would   be   unintelligible.] 

Dr.  BozEMAN  has  modified  this  speculum,  giving  to' it  greater  di- 
mensions, and  re -placing  the  terminal  hook  with  another  instrument, 
either  larger  or  smaller,  so  that  two  speculums  are  united  in  the  same 
instrument. 

The  position  requisite  to  be  given  to  the  patient  is  of  sufficient 
importance  to  legitimatize  some  observations ;  and,  to  begin  with,  we 
admit  that  Dr.  Makion  Sims  may  have  discovered  it,  on  his  part,  but 
as  to  j^rioritij  he  can   not  claim  it  for   an   instant. 

In  fact,  ScHKEGEK  published,  in  1817,  a  case,  in  which  he  obtained 
an  almost  complete  cure  after  the  applications  of  the  suture.  "The  pa- 
tient kneeled  on  the  edge  of  a  bed,  supporting  the  upper  part  of  the 
body  on  a  rolled  mattress,  so  as  to  form  by  it  and  the  thighs  a  right 
angle,  the  latter  separated  as  far  as  possible." 

In  1829,  J.  Pn.  Roux  attempted  the  cure  of  a  Vesico -Vaginal  Fis- 
tula by  a  suture.  "  The  patient  was  made  to  lie  on  her  belly,  the 
thighs  separated,  sustained  by  aids,  the  pelvis  more  elevated  than  the 
head,"  &c. 

In  1839,  M.  Velpeau  recommended  the  same  position:  An  assis- 
tant, he  says,  holds  the  vagina  dilated  by  means  of  a  large  grooved  in- 
strument of  metal,    horn,  or  wood,  &c. 

In  1834,  the  same  thing  had  been  accomplished  in  England  by 
Gasset,  in  a  very  remarkable  case,  to  which  we  may  return. 

About  1841,  WuTZER,  who  occupied  himself  successfully  in  Germany 
on  the  same  matter,  adopted  decubitus  in  pronatione  as  the  position. 


1*72  Tlie  Peninsular  and  Independent. 

It  would  be  superfluous  to  multiply  citations,  in  order  to  prove  that 
long  before  1845  many  surgeons  had  recognized  the  advantages  of  the 
above  attitude. 

[The  French  author,  M.  Veuneuil,  discusses  at  considerable  length 
the  relative  merits  of  different  positions.  It  seems  hardly  necessary  to 
follow  him  through  several  pages  devoted  to  this  suVyect.  His  conclu- 
sions appear  to  be  more  in  favor  of  decubitus  in  pronatione,  when  the 
operation  is  to  be  performed  without  anaesthesia  of  the  pati6nt,  but  when 
chloroform  is  to  be  administered,  he  prefers  the  patient  to  be  placed  on 
her  side.  Though  the  operation  is  not  attended  with  so  much  pain  as 
to  make  anaesthesia  desirable,  yet  when  it  is  judged  requisite  to  depress 
the  fistula  (by  the  use  of  an  instrument  of  whalebone  introduced  into 
the  urethra)  so  as  to  bring  it  into  view,  it  is  much  more  easy  to  ac- 
complish the '  depression,  with  the  patient  under  the  influence  of  chlo- 
roform.] 

Dr.  Sims  appears  to  have  been  himself  struck  with  the  inconvenien- 
cies  of  thcposition  in  jyronatione  which  he  had  at  first  so  much  vaunted. 
In  his  second  pamphlet  he  has  counselled  another,  applicable,  according 
to  him,  in  the  greatest  number  of  cases,  and  which  he  describes  in  the 
following  manner: 

"  The  patient  lies  on  her  left  side,  the  thighs  flexed  nearly  to  a 
right  angle  with  the  pelvis,  the  right  thigh  a  little  more  than  the  left. 
The  left  arm  is  thrown  backwards,  the  thorax  turned  downward  so  that 
the  sternum  is  applied  in  contact  with  the  bed.  The  vertebral  column 
is  in  complete  distension,  and  the  head  reposes  upon  the  left   parietal." 

We  will  continue  the  exposition  of  Dr.  Sims'  method  in  the  same 
order;  that  is,  in  making  his  description  march  in  front,  the  historical 
criticisms,  and  our  personal  appreciations  follow. 

Ah.  VERNEUIL. 


(From  the    ''  Oeslcrreichische  Zei/schrift  fiir  Praktische  JTeilkunde.^') 

EXCERPTS  from:  PROFESSOR  CHRASTINA'S   REPORT  OX  THE  RELATIVE 
NUMBER  OF  HEALTH  OFFICERS  IN  THE  CITY  AND  COUNTRY. 

No  one  can  exercise  the  calling  of  priest,  of  advocate,  of  notary,  or 
of  magistrate,  if  he  has  not  made  a  full  coarse  in  the  faculty  to 
which  he  intends  to  belong,  and  perfected  himself  in  his  own  spe- 
cial sciences.  Certainly,  men  who  have  charge  of  the  noblest  interests 
of  humanity  —  health  —  should  possess  all  the  knowledge  of  Medicine 
that  can  be  obtained  by  stud}'.  But  how  can  it  be  possible  for  a 
surgical  candidate,  a  j^oung  man  of  no  previous  cultivation  of  mind 
suitable,  to  master,  in  the  space  of  three  years,  such  weighty  matters 
as  anatomy,  phj^sic,  chemistry,  physiology,  surgery,  &c.,  in  a  manner 
worthy  of  claiming  the  confidence  of  the  public,  as  a  practitioner? 
Neither   his   previously  acquired   knowledge,  nor   the    grade  of  his  sub 


Selected  Articles^  Abstracts^  dbc,  173 

sequent  training,  are  such  as  well  enable  him  to  understand  these 
studies.  Besides,  the  course  is  run  over  in  such  a  cursory  manner 
that  the  best  scholars  even  would  not  be  able  to  comprehend  it  in 
this  interval.  Yet  the  student  of  Medicine  must  pursue,  as  a  pre- 
paratory study,  a  fundamental  training  of  eight  years,  and  then  still 
devote  Jive   more   years   to   professional   subjects. 

In  earlier  times,  when  the  medical  sciences  had  not  yet  extended 
far  beyond  their  primitive  bounds;  when  still  a  sparing  knowledge 
of  descriptive  anatomy,  physiology,  and  pathology  was  sufficient  to. 
procure  a  doctorate;  when  the  expulsion  of  a  tape-worm  was  esteemed 
half  a  miracle ;  when  organic  anatomy,  chemistry,  and  microscopy 
were  but  very  little,  or  not  at  all,  introduced  into  medicine,  — then, 
at  that  time,  the  institutes  of  sui-gery  were  established  —  transmitted 
from  the  same  original  fountain  of  medical  knowledge;  but,  at  the 
present,  when  the  mere  handling  and  overlooking  anatomy  with  un^ 
armed  eye  is  no  longer  sufficient ;  when  the  subject  is  dissected  to 
the  most  invisible  fibre  and  cell,  and  these  again  traced  in  the  em- 
bryonic state,  where  we  seek  to  fiithom  the  most  enigmatical  functions 
of  the  human  organism; — in  short,  in  a  time  when  medicine  has. 
undergone  a  complete  revolution,  and  neither  can,  nor  must,  remain 
in  the  rear  of  the  other  natural  sciences,  hastening  forward  as  they 
are  with  giant  strides,  —  in  such  a  time,  I  maintain  that  the  inferior 
chirurgical  institutions  are  no  longer  in  unison  with  the  remaining 
systems  of  mental  culture,  in  full  tide  of  successful  experiment,  and 
soaring  aloft   in   Austria 

It  is  really  wonderful  that  in  the  midst  of  these  troubles  —  these 
prospects  that  oppress  the  Medical  Profession,  like  a  leaden  weight  — 
the  Medical  Sciences  remain  in  such  splendor;  that  the  Medical  Fa- 
culties of  Vienna  and  Prague  belong  to  the  most  renowned,  and  are 
acknowledged  as  such,  in  the  whole  world.  The  outside  world  show 
this  appreciation,  by  sending,  yearly,  multitudes  of  young  men  to 
Vienna  and  Prague,  to  seek  out,  and  profit  by,  the  teachings  of  our 
high  schools.  But  in  order  not  to  paralyze,  in  the  end,  these  hitherto 
abundant  capabilities,  it  is  high  time  to  cast  about  for  ways  and 
means  that  may  be  suitable,  whereby  this  tedious  and  self- devoting 
study,  united  with  so  much  expense  of  time  and  money,  may  have 
opened  out  a  prospect  of  sufficient  exercise  and  remuneration,  and 
not   need   to   suffer   with   hunger,   or   starve   for   want   of  use. 

In  1838,  there  were  300  physicians  to  a  population  of  about 
400,000,  and  still  there  was  no  complaint  for  want  of  health  officers, 
nor  did  the  physicians  complain  of  being  overburthened  with  business 
—  much   less,  for   a   destitution   of  the  means   of  living. 

This  state  of  things  has  altered.  With  the  oversupply  of  me-, 
dical  men  still  increasing,  there  are  but  few  now  so  happy  as  to  be 
able,   by  practice   constantly,  to   support  their  families:    rari   nantes  in 


174  The  Peninsular  and  Independent. 

gurgito  vasto,.  Most  practitioners  having  no  other  source  of  income, 
Jiave  hard  work  to  cover  their  daily  expenses,  but  many  have  no 
sufficient   employment   to   that   end,    and  even   more    must   suffer 

It  may  be  the  case  that,  with  time,  the  ardor  of  scientific  zeal 
will  cool,  and  that  students  about  to  select  a  profession  will  turn 
their  backs  upon  the  thorny  path  of  Medicine,  well  persuaded  that 
the  deceptive  adage,  dat  Galenus  opes^  can  only  be  applied  in  rare 
cases,  and  that  the  future  generations  will  vote  it  a  myth  from  the 
hoary   times   of  antiquity. 

The  whole  number  of  civil  health  officers  in  Lower  Austria,  con- 
sists in  123  Doctors  of  Medicine,  and  630  Surgeons ;  the  population  being 
1,065,000.  On  an  average,  there  is  one  physician  to  every  800  in- 
habitants, and  one  surgeon  to  every  1500.  If  we  compare  the  me- 
tropolis, Vienna,  with  the  "rural  districts,"  there  we  find  the  dis- 
proportion of  doctors  to  inhabitants  as  ten  to  one  for  city  and 
country;  whilst  in  Vienna  there  is  one  DorAor  of  Medicine  to  every 
800   inhabitants,    and   in   the   country   one   to   every   8,000. 

The  very  natural  inquiry  arises :  What  hinders  the  graduated 
physician  from  settling  in  the  country?  Why,  for  example,  in  the 
near  vicinity  of  Vienna,  in  Hiittelburgh,  Purkersdorf,  Neulengbach,  and 
in  other  places,  the  seats  of  district  officers,  is  there  no  doctor?  I 
have  the  answer:  All  these  places  have  been  tried  by  doctors,  as  I 
could  substantiate  by  their  names,  but  they  could  not  succeed.  In 
every  place  there  is  a  surgeon,  that  lives  on  an  easy  footing  with 
the  community,  is  allied  or  related  with  many  of  the  families,  keeps 
a  house-apothecary,  carries  his  death-warrant  in  hand,  confided  in  by 
the  whole  population,  so  that  the  most  shilJfal  'pliy^ician  has  no  chance 
in  a  concurrence  with   him. 

The  higher  species  of  breeding  of  the  Medical  Practitioner  —  his 
manners,  his  mode  of  speech,  and  style  of  conversing  —  his  bearing, 
in  his  intercourse  with  the  people,  all  conspire  to  make  the  com- 
mon man  believe  that  such  a  gentleman  would  require  a  much 
larger  fee  than  the  surgeon,  living  with  him  in  fellowship,  and  fra- 
ternizing in  his  amusements  with  him,  and  who,  on  his  side,  lets  no 
occasion  or  opportunity  fail  to  cunningly  battle  for  his  aria  et  focis^ 
at  the  expense  of  his  more  learned  competitor,  and  to  conquer  a  sub- 
sistance;  whilst,  in  reality,  such  a  place  is  seldom  in  condition  to  sup- 
port two  practitioners. 

The  surgeon  charges  for  a  visit  to  a  patient,  from  10  to  20  kreu- 
zer  (^%  to  5  cts.) ;  but  at  the  same  time  he  has  30  kreuzer  for  his 
flask  of  mallows  tea,  30  for  his  salve,  30  for  cupping,  30  for  the  plas- 
ter, and  a  separate  charge  for  every  other  unavoidable  article  by  each 
patient,  but  which  the  counbyman,  who  thiwks  only  what  strikes  the 
eye  of  any  value,  finds  all  very  cheap,  because  the  visit  costs  so  little. 
But  the  doctor,  confident   in   the   advancement  of  the   medical  sciences 


Selected  Articles^  Abstracts,  €Jbc.  1T5 

and  not  willing  to  victimize   his   patient  with  an  extensive,  and  for  th 
most   part   useless,  trade  in  vesicatories,  cerates,    and  emplastrams,  and 
wishing   to   elevate  his    art  somewhat   higher,    is,    therefore  unwelcome 
to  the  countrymen. 


•  ♦  • 


ABSTRACTS  AND  SELECTIONS  for  the  PENINSULAR  AND  INDEPENDENT. 


By  M.  a.  Patterson,  M.  D.,  Tecumseh. 

TRAUMATIC  TETANUS  SUCCESSFULLY  TREATED  BY  ATROPIA. 

The  editors  of  the  Kentucky  Semi-MontMy  Medical  ISTews^  have  pub- 
lished the  successful  treatment  of  a  formidable  case  of  tetanus  by  free 
use  of  atropia.  The  patient  was  a  lad  aet.  14.  The  cause,  a  lacer- 
ated pistol  wound  of  left  hand,  received  27th  of  December  last.  On 
the  evening  of  January  12th,  convulsions  occurred;  the  spasms  for  a 
time  were  allayed  by  the  applications  of  chloroform,  but  fearing  its 
toxic  effects  upon  the  blood,  repeated  and  greatly  prolonged  anesthe- 
sia was  regarded  as  altogether  too  hazardous.  On  the  15th  of  Janu- 
ary, at  10  A.  M.,  he  took  1-20  gr.  of  atrophine;  similar  doses  were 
repeated  every  three  hours,  which  kept  him  fully  under  the  influence 
of  the  medicine,  with  the  effect  of  gradually  abating  the  force  and 
frequency  of  the  spasms.  On  the  15th,  the  atrophine  was  reduced 
to  1-40  grain  every  three  hours.  Spasms  and  delirium,  more  or  less 
severe,  continued  until  the  20th,  when  these  manifestations  were  so 
slight  the  atrophine  was  discontinued.  The  trismus  and  muscular  ri- 
gidity subsided  very  slowly.  During  the  progress  of  the  case,  other 
means  were  emploj'-ed  to  meet  temporary  symptoms ;  which  will  be 
readily  suggested  to  the  mind  of  any  intelligent  physician  who  may 
chance   to   have   a  case   of  this    fearful   nature    under   his    charge. 

The  following  remarks  are  so  judicious  we  can  not  resist  the 
inclination   to   present   them   to   the  readers   of  this  Journal: 

Chloroform,  without  doubt,  is  the  most  efficient  agent  for  the  control 
of  the  spasms,  but  unfortunately  its  toxic  effects  upon  the  blood  unfit  it 
for  cases  where  long  persistency  of  influence  is  required.  And  all  authors 
who  have  observed  and  written  much  in  regard  to  tetanus,  teach  us  to 
place  our  principal  reliance  for  success  in  the  safe  conduct  of  our  patient 
through  the  first  four  or  five  days,  after  which  the  disease  is  spoken  of  as 
"chronic"  and  manifesting  a  tendency  towards  spontaneous  subsidence. 
Our  measures  of  treatment  were  from  the  first  directed  towairds  the  attain- 
ment of  this  end.  One  of  the  most  strongly  urged  points  of  tieatment  in 
this  case,  and,  as  we  conceive  one  of  the  most  important,  was,  that  our 
patient  should  be  kept  absolutely  free  from  all  needless  sources  of  excitation. 
Strange  flices  were  prohibited  from  his  room  —  noises  were  interdicted  — 
his  nurses  were  admonished  to  be  gentle,  calm,  and  quiet  in  their  atten- 


176  The  Peninsular  and  Independent. 

tions;  sudden  currents  of  cold  air,  and  all  unnecessary  contacts  with  his 
bed,  or  touching  his  person  without  previously  apprising  him  were  avoided. 
.  ,  .  .  Then,  if  pjactitioncrs  would  content  themselves  with  simply 
moderaiiny  the  violence  of  the  convulsive  paioxysms  of  tetanus,  by  euch 
agents  as  may  be  found  best  suited  to  each  individual  case,  and,  sup- 
porting their  patient's  strength,  look  to  the  ultimate  spontaneous  ces- 
sation of  the  disease,  we  sincerely  believe  that  its  mortality  would  be 
materially  lessened,  although  it  may  long  continue  to  be  classed  as  one  of 
the  opprobria  of  our  Profession. 


APPLICATION  OF  GLYCERINE  IN  VARIOLA. 

Dr.  PosNEK,  editor  of  the  Medical  Central  Zeitung^  in  the  January 
No.,  1859,  of  his  journal,  recommends  the  application  of  Glycerine  in 
Variola,  affirming  that  it  protects  and  secures  the  patient  against  the 
Variola  deformity. 

lie  was  led  to  the  use  of  Glycerine,  in  consequence  of  the  entreaties 
of  his  patients  for  some  application  that  would  relieve  the  distressing 
pain  in  the  pustules;  for  this  purpose  he  directed  the  anointing  of  the 
painful  parts  every  two  hours,  with  pure  Glycerine.  His  anticipations 
were  answered  —  the  pain  and  tension  being  overcome. 

It  chanced  that  the  first  two  patients  upon  whom  the  remedy  was 
tested,  were  completely  coveied  with  pustules,  which,  upon  the  face, 
were  confluent.  Great  deformity  was  expected ;  but  when  the  scales 
fell  off,  contrary  to  every  anticipation,  the  scars  that  remained  were 
small  and  on  a  level  with  the  skin  —  they  were,  however  of  such  a  dark 
color  that  the  patients  looked  like  mulattoes. 

Out  of  instinct,  not  in  obedience  to  direction,  the  convalescents 
continued  the  application  of  the  Glycerine,  and  after  six  weeks,  the 
discoloration  had  disappeared  and  the  scars  were  scarcely  visible.  Since 
then  a  number  of  patients  have  been  thus  protected. 

Great  care  must  be  taken  that  the  Glycerine  is  perfectly  pure. 

[Med.  cC  Surg.  Reporter. 


ERGOT  IN  PHTHISIS  PULMONALIS. 

Ergot,  originally  recommended  by  a  French  physician  for  Phthisis, 
has  recently  been  tried  by  Dr.  Staats,  of  Albany,  N.  Y.,  with  decided 
benefit,  as  he  supposes,  in  three  well  marked  cases  of  consumption. 
From  the  New  York  American  Medical  Monthly^  for  May  last,  we  learn 
that  he  prescribed,  4  gr.  of  powdered  ergot,  \  gr.  of  ipecac,  with  1-10  gr. 
of  sulph.  of  morphia  ever}'-  six  hours;  a  strong  liniment  of  acetic  acid 
and  spirits  of  turpentine  to  the  chest,  and  a  full  animal  diet." 

With  such  important  adjuvants,  the  therapeutic  agency  attributed  to 
the  ergot  may  well  be  questioned.  The  asserted  object  of  his  communi- 
cation is  to  call  attention  to  the  remedy,  that  it  may  be  fairly  tested,  and 
with  this  view  we  notice  his  remarks. 


Selected  Articles^  Abstracts^  dbc.  177 

TARTRATE  OF  IRON  AND  POTASH  IN  PHAGENDIC  ULCER. 

M.  RicoRD,  of  Paris,  recommends  this  salt  very  highly  in  certain 
forms  of  syphilis.  AYe  have  used  it  frequently,  with  truly  surprising 
results.  We  now  recall  to  mind  a  case  in  which  a  very  large  ulcer 
threatened  to  destroy  the  glans  penis.  The  young  man  was  brought 
very  low  by  exhausting  haemorrhages,  and  the  ulcer  was  rapidly  pro- 
gressing. In  consultation  with  his  attending  physician,  -we  advised  from 
5  to  10  grains  tartrate  of  iron  and  potash,  three  times  a  day,  with  a 
strong  solution  of  the  same  constantly  applied  to  the  affected  part  on 
lint.  The  bleeding  was  soon  arrested,  and  the  deep  ulcer  filled  up  with 
wonderful  rapidity.  TVe  have  used  the  remedy  many  times  since,  and 
are  always  pleased  with  its  effects  in  similar  cases. 

[Southern  Med.  and  Surg.  Journal. 

NEW  METHOD  OF  CURING  HYDROCELE. 

In  the  Edinburgh  Medical  Journal  for  December,  1858,  is  a  state- 
ment that  Dr.  Simpson  reported  to  the  Medico -Chirurgical  Society,  the 
complete  cure  of  a  case  of  Hydrocele  by  the  following  method : 

A  slender  wire,  or  metallic  seton,  "  was  passed  through  the  sac,  by 
first  traversing  the  sac  from  below  upwards  with  a  long -handled  surgical 
needle,  such  as  is  used  in  transfixing  and  tying  haemorrhoids,  threading 
the  eye  of  the  needle  after  it  was  projected  through  the  scrotum  above 
with  three  or  four  slender  iron  threads,  pulling  the  needle  then  back- 
wards through  the  sac  and  out,  and  thus  leaving  the  metallic  seton  in 
its  place.  The  liquid  drained  off  in  an  hour  or  two ;  adhesive  inflam- 
mation set  in,  and  progressed  for  two  days,  when  it  began  to  subside. 
The  wires  were  removed  on  the  third  day,  and  the  cure  had  remained 
apparently  quite  complete,  with   the  vaginal   sac  firm  and  consolidated. 

This  method  of  treating  Hydrocele  was.  Dr.  S.  held,  much  simpler 
in  its  performance  than  tapping  and  injecting;  not  by  any  means  so 
painful  to  the  patient ;  less  likely  to  produce  a  suppuration  or  danger- 
ous amount  of  inflammation  ;  and,  perhaps,  experience  would  show  also, 
betimes,  that  it  was  surer  and  more  certain  in  its  results. 

In  connection  with  this  subject,  we  notice  in  the  Lancet^  a  case  at 
the  Westminster  Hospital,  in   which 

Mr.  HoLTHOUSE  passed  a  needle  with  a  silk  ligature  through  the  most 
depending  parts  of  the  hydrocele,  squeezed  out  the  serous  contents,  and 
tied  the  two  ends  together. 

Sufficient  time  had  not  elapsed  to  determine  the  result,  although  it 
js  probable  from  the  known  effect  of  metallic  wires  on  living  tissues  that 
the  iron  seton  will  be  found  preferable  to  silk. 

The  same  authority  states  that 

M.  Chassaignac,  of  Paris,  introduced  one  of  his  drainage  tubes  to  effect 
the  same  purpose,  by  means  of  a  trochar,  upon  which  the  tube  is  intro- 

VoL.  II. -M. 


178  TliQ  Peninsular  and  Independent. 

duced   completely   through   the  hydrocele,    thus   acting   the   part    of   a 
canula." 


OZCENA. 

Occasionally  we  meet  with  cases  of  Ozoena  which  are  very  distress- 
ing to  the  patients  and  perplexing  to  the  physician.  Hitherto  our  most 
successful  treatment  consisted  in  the  introduction  of  a  seton  in  the  nape 
of  the  neck;  injections  into  the  nostrils  of  nitrate  of  silver,  or  sulp.  zinc, 
and  the  internal  use  of  Fowler's  arsenical  solution ;  the  latter  changed 
for  special  anti  -  scrofulous  medication  when  indicated.  The  cure  of  an 
obstinate  case  is  related  by  Dr.  H.  F.  Campbell  {Southern  Medical  and 
Surgical  Journal^  March,  1859).  He  applied  to  the  diseased  Schneidarian 
Membrano,  three  or  four  times  a  day,  a  solution  made  by  dissolving  two 
grains  of  iodine  in  one  ounce  of  glycerine.  At  the  same  time  a  mixture 
composed  of  Huxam's  tincture  of  bark  |  viij.,  iodide  of  potassium  3  ij., 
was  administered  in  doses  of  a  tablespoonful,  mixed  with  sweetened  water, 
three  times  a  day. 


UTERINE  DISEASE  THE  MAIN  CAUSE  OF  NURSING  SORE   MOUTH. 

Dr.  M.  M.  Fallen  ( St.  Louis  Med.  &  Surg.  Journal )  remarks : 

From  the  uniformity  with  which  I  have  met  with  disease  of  the 
uterus  in  stomatitis  matcrna  I  have  concluded  that  it  plays  an  important 
part  in  the  production  of  the  disease.  I  suppose  that  the  affection  exists 
prior  to  the  sore-mouth,  and  pregnancy  or  lactation,  as  the  case  may  be, 
increases  it  to  such  an  extent  that  gastric  derangement  results,  and  this  is 
followed  by  the  trouble  in  the  mouth. 

This  hint  is  simply  valuable  to  direct  attention  to  the  condition  of  the 
womb  when  symptoms  of  stomatitis  materna  occur.  There  is,  however, 
more  danger  of  needless  interference  with,  than  neglect  of,  this  organ  in 
this  age  of  speculums  and  Bennetisms. 


VOMITING  DURING  PREGNANCY. 

In  some  obstinate,  and  rather  alarming,  cases  of  vomiting  continued 
to  advanced  pregnancy,  until  the  stomach  itself  became  seriously  affected, 
as  proved  by  altered  secretion,  Dr.  Gros  {Bui.  Genl.  de  Thera2oeutique) 
speaks  of  prompt  relief  being  afforded  by  the  administration  of  pepsine. 


ADDITIONAL  TESTIMONY  OF  THE  VALUE  OF  IRON  IN  THE  TREATMENT 
OF  SCARLATINA. 

Dr.  Bishop,  of  Davenport,  reports,  in  the  February,  1859,  No.  of  the 
Lancet^  fifty -one  cases,  some  of  them  quite  malignant,  of  scarlatina, 
recently  treated  by  himself,  with  the  loss  of  but  one  patient.  He  attributes 
this  exemption  from  the  usual  fatality  of  the  disease  in  Davenport,  to  the 
employment  of  tonics  from  the  first:  "either  citrate  of  iron  or  the  tincture 


Selected  Articles^  Abstracts^  <&c.  179 

•of  the  sesqui  -  chloride  in  the  usual  full  doses."  He  applied  no  caustics  to 
the  throat  or  tonsils,  but  used  external  applications  of  vol.  camph.  liniment, 
or  turpentine  sprinkled  on  a  strip  of  flannel  previously  wrung  out  of 
hot  water,  and  applied  around  the  neck  several  times  in  twenty -four 
hours. 


TREATMENT  OF  ERYSIPELAS  OF  THE  LIMBS  BY  ELEVATION 

A  plan  of  treatment  practiced  at  the  Middlesex  Hospital,  England,  for 
erysipelas  of  the  limbs,  is  merely  the  practical  application  of  a  general 
principle  which  is  too  often  neglected. 

It  consists  in  elevating  the  affected  leg  or  arm  in  a  vertical  position 
above  the  horizontal  plane  of  the  body.  This  causes  a  subsidence  of 
the  swelling,  and  removes  the  pain;  the  circulation  in  the  veins  is  ac- 
celerated towards  the  heart,  and  the  hitherto  inflamed  and  red  skin  as- 
sumes a  pallid  aspect.  [Lancet,  Fed.  1859. 


OBSTINATE  VOMITING. 

Dr.  H.  Buss,  of  Shoreditch,  in  the  report  of  a  case,  incidentally 
remarks : 

I  put  in  practice  Dr.  Steggol's  plan  of  arresting  obstinate  vomiting ; 
ten  -  grain  doses  of  sulph.  of  magnesia  in  half  an  ounce  of  water  every 
half  hour  —  a  dernier  resort  which  has  never  yet  failed  me. 

[lUd, 

ATROPIA  IN   EPILEPSY. 

Dr.  Max  Maresch  (  Wienerzeitschrieft),  Physician  to  the  Vienne 
Hospital  for  the  Insane,  prescribed  the  Atropia  in  eighteen  cases  of 
Epilepsy;  three   were   completely  cured,    and   thirteen  much  improved. 

The  one-fiftieth  of  a  grain  was  given  every  morning  before 
breakfast  for  a  period  of  from  sixty  to  ninety  days — an  intermission 
of  thirty  to  forty-five  days  allowed  to  the  patient,  and  then  the 
medicine  again  prescribed.  It  is  important  that  the  patient  use 
neither  coffee  nor  cocoa,  as  the  active  principles  of  these  counteract 
the   physiologial   effects  of  the  Atropia. 

In  the  above  dose,  the  usual  symptoms  of  balladonna  were 
produced. 

[Med.  &  Surg.  Reporter,  trans,  ly  Dr.  Demme. 


OF  THE   TREATMENT   OF  ORGANIC  STRICTURES   OF  THE   URETHRA  BY 
IODIDE   OP  POTASSIUM. 

Dr.  Thielmann,  surgeon  of  one  of  the  hospitals  of  St.  Petersburgh, 
has  utterly  relinquished,  the  last  thirteen  years,  the  use  of  mechan- 
ical  means   habitually   employed  for   organic  strictures   of  the  urethra, 


180  The  Peninsular  and  Independent. 

which  he  treats  exclusively  by  iodide  of  potassium.  This  medicatiorr 
has  perfectly  succeeded  in  twenty -seven  cases  of  stricture,  presenting 
a  great  ■  diversity  with  respect  to  seat,  extent,  structure,  etc.  With 
the  greater  part  of  the  patients  a  more  a  less  copious  gonorrhoeal 
discharge  was  present  at  the  same  time.  The  oldest  strictures  were 
of  two   years'   standing,    the  most  recent   of  eight    months'. 

Dr.   TiiiELMANN    exhibited    to  each    of   his    patients    three    table- 
spoonfuls   a   day    of   the  following  solution : 

Vf..     Potassa  lodidi 2  dr. 

Aqua    destill. Sj  oz. 

He  prescribed  a  rigid  milk  diet,  permitting  amjdaceous  food.  .  . 
It  was  sometimes  requisite  momentarily  to  suspend  the  use  of  the 
iodide  in  order  to  avoid  the  accidents  that  might  be  superinduced 
by  its  protracted  uses.  The  duration  of  the  treatment  varied  from 
a  fortnight  to  two  months,  when  the  inodular  tissue  of  the  strictures 
was  felt  externally.  Dr.  T.  ordered,  in  addition,  frictions  along  the 
part  of  the  penis  corresponding  to  the  urethra,  with  an  ointment 
composed   of 

% .     Potassa  iodid 1  dr. 

Adipis 1  oz. 

The  gonprrhoeal  discharge  for  the  most  part  ceased  spontaneously. 
When   it  was  persistent,    it   was    treated  by   the    ordinary  means. 

\JSIed.  Zeit.  Russlands,  and  Journ.  Tract.  Med.  &  Surg. 

VEGETABLE  PARASITES  OF  THE  HUMAN  SKIN. 

Mr.  Jabez  Hogg,  read  an  interesting  paper  on  this  subject  before  the 
medical  societ}''  of  London  (January  24,  1859),  the  object  of  which  was  to 
show  the  fallacy  of  the  theory  prepounded  by  certain  physicians,  who  at- 
tributed certain  special  diseases  of  the  skin  to  a  vegeta'ble  parasite  peculiar 
to  disease  in  question ;  thus,  that  the  porrigo  favosa  (the  cupped  or  honey- 
comed  ringworm  of  \Villan)  is  caused  by  a  parasitic  fungi  called  acliorion 
Sclwnleinii ;  that  the  porrigo  scutulata  of  Willan  II  due  to  the  parasite 
tricoi^liy ton  tonsurans  ;  that  the  porrigo  decalvans  is  ^wo,  io  iha  microspo- 
ron  Audouini ;  that  sycosis  or  mentagra  is  due  to  the  microsi^oron  menta- 
gropliitcs  ;  and  that  the  pityriasis  versicolor  is  due  to  the  onicrosj^oron  fur- 
fur. The  author  combated  this  hypothesis  by  exhibiting  the  microscopfc 
appearances  of  the  fungi  which  were  found  in  the  products  of  these  dis- 
eases, and  showed  that  the  same  fungi  were  common  to  all,  as  also  to 
other  skin  diseases  not  included  in  the  category  of  other  authors ;  and 
summed  up  his  arguments  as  follows  :  Fungi  are  well  characterized  through- 
out nature  by  feeding  on  effete  or  decayed  matter  ;  the  fungi  supposed  to 
be  peculiar  to  certain  diseases  of  the  skin  were  also  found  in  many  other 
diseases  of  the  cutaneous  surface  ;  competent  observers  had  not  been  able 
to  find  them  in  those  peculiar  diseases  ;  sporules  and  filaments,  described 
as  the  cause  of  one  definite  disease,  had  been  found  in  the  products  of 
another  definite  disease,  supposed  to  have  a  parasite  of  its  own,  dif- 
ering  from  this  and  peculiar  to  itself;  and,  lastly,  attempts  had  been 
made  in  vain  to  implant  these  parasites  in  the  healthy  skin ;  hence  one 
could   not   but   conclude  that  the  whole  theory  was  erroneous,  and  that 


r 

Selected  Articles^  Abstracts^  (&c.  181 

special  parasites  peculiar  to  and  productive  of  special  diseases  did  not  exist. 
It  was  the  author's  conviction  that  the  fungi  found  on  the  skin  and  hair 
were  not  primarily  the  cause,  but  rather  the  result,  of  disease. 

[Brit.  Med.  Journal,  Feb.  1859. 
PERSULPHATE   OF  IRON"  IK"  EPISTAXIS, 

Dr.  HiBBARD,  of  Richmond,  Ind.,  promptly  arrested  a  profuse  and 
alarming  nasal  hsemorrhage  by  injecting  into  the  nostril  "  3  ss.  of  a  mix- 
ture consisting  of  a  solution  of  persulphate  of  iron  one  part,  rain- 
water ten  parts."     He  remarks  : 

The  points  of  this  case  worthy  of  notice  are  —  1.  The  hsemorrhage, 
after  resisting  all  ordinar}^  measures,  was  arrested  at  once  upon  the 
application  of  a  diluted  solution  of  the  persulphate  of  iron;  2.  The 
application  was  convenient  and  without  pain  to  the  patient;  3.  The  nostril 
was  left  clear  of  clots,  irritation,  or  other  unpleasant  consequence  of  either 

the  lesion  or  the  medication The  preparation  I  used 'was  a  solution 

of  the  salt  as  made  and  used  as  a  ferruginous  tonic  by  J.  T.  Plummer,  M.D. 
of  this  city ;  and  as  the  process  appears  to  me  much  more  simple  than 
that  of  M.  MoNSEL,  I  subjoin  it  with  Dr.  Plummer's  approbation: 

R.     Sulphate  of  Iron    .         .         .         .         .         .  1  ijss. 

Nitric  Acid     .......  |  iij. 

Water    ........  |  xss. 

Triturate  the  salt  and  the  acid  together  for  fifteen  minutes ;  then  add 
the  water  and  filter  through  paper.  [  Lancet  &  OMerver. 

PROLAPSUS  UTERL 

W.  E.  Nourse,  a  Brighton  Surgeon,  relates  in  the  March  No.  of  the 
London  Lancet,  tlie  successful  treatment  of  a  very  bad  case  of  this  malady, 
of  three  years  standing,  by  a  simple  application  of  the  ])rinci;ple  upon 
which  the  success  of  the  surgical  operation  for  prolapsus  uteri  depends, 
viz.  :  partial  occlusion  of  the  vagina.  The  favorable  termination  of  the 
case  affords  a  striking  illustration  of  the  importance  of  decided  and  pre- 
cise directions,  and  of  the  efficacy  of  continued  unremitting  mechanical 
support.  '  After  replacing  the  womb,  he  directed  that  it  should  never  again 
be  allowed  to  descend  externally — "That  a  sort  of  thick  pad  or  cushion, 
of  a  length  and  breadth  sufficient  to  cover  the  external  parts,  should  be 
applied  and  kept  in  its  place  by  a  broad  and  firm  T  bandage  before  she 
again  rose  from  the  recumbent  posture  ;  that  she  should  always  put  one 
on  before  rising  from  her  bed  in  the  morning,  just  as  a  ruptured  person 
puts  on  a  truss,  and  should  never  go  abroad  without  one  ;  and  lastly,  that  she 
should  introduce  every  night  into  the  vagina,  a  few  grains  of  tannic  acid 
made  up  into  a  sort  of  soft  pill." 

On  the  same  subject,  according  to  the  Medical  Journal  of  North  Car- 
olina., Dr.  Bonordon  observes,  that  as  a  prolapsus  uteri  usually  arises  from 
hypertrophy  of  the  organ  and  a  relaxed  state  of  the  round  and  broad  liga- 
ments, the  indications  are  to  remove  the  hypertrophied  condition,  and  to 


182  The  Peninsular  and  Independent. 

strengthen  the  ligaments.  In  two  cases  he  has  been  enabled  to  completely 
fulfill  them  by  internal  remedies.  lie  administered  twenty  drops  of  tr, 
ferri.  mur.  morning  and  evening,  giving  with  the  evening  dose  also  three 
gr.  secale  cornut,  and  ten  gr.  of  gum  galhanum,  the  external  parts  of  gen- 
eration being  well  rubbed  several  times  a  day  with  Hoffman's  halsamum 
vitce.  At  night,  the  patients  were  directed  to  lay  with  the  pelvis  some- 
what raised.  The  secale  was  continued  for  fourteen  nights,  next  alternate 
nights,  then  a  while  at  longer  periods. 


RE-INTERMENT  OF  THE  REMAINS  OF  JOHN  HUNTER. 

The  following  rare  bit  for  the  medical  antiquary  the  iV!  Y.  Journal 
credits  to  the  London  Times  &  Gazette.  'As  public  notice  had  been  given 
that  the  re-interment  would  take  place  in  the  xVbbcy  on  ^Monday  after  the 
afternoon  service,  and  that  an  appropriate  anthem  would  be  given,  an 
unusually  large  congregation  had  assembled,  and  great  numbers  of  medical 
men  attended  in  addition  to  those  who  had  obtained  tickets  at  the  College. 
There  was  no  funeral  service,  but  the  words  of  the  anthem  were  peculiarly 
appropriate :  '  "When  the  ear  heard  him,  then  it  blessed  him ;  when  the 
eye  saw  him,  it  gave  witness  to  him ;  he  delivered  the  poor  that  crieth, 
the  fatherless,  and  him  that  hath  none  to  help  him.  .  .  .  His  body 
is  buried  in  peace;  his  name  liveth  evermore.'  While  the  service  was 
proceeding,  the  Council  of  the  College  and  many  gentlemen  invited  to 
join  in  the  ceremony,  assembled  in  the  Jerusalem  Chamber,  the  room  in 
which  Henry  the  Fourth  died,  after  having  been  brought  there  from  the 
Confessor's  Shrine  in  |the  Abbey  in  a  fit  of  apoplexy.  There  were  those 
present  who  recalled  the  words  of  the  djnng  king,  as  embalmed  by 
Shakspearc  in  his  historical  play,  and  of  Congreve  and  Addison  Ij'ing  in 
state  in  the  same  room  before  their  interment  in  the  Abbey,  so  well 
described  by  Goldsmith  as  '  the  place  of  sepulture  for  the  philosophers, 
heroes,  and  kings  of  England'  and  there  was  a  general  feeling  of  pride 
on  the  occasion  of  adding  the  remains  of  one  of  England's  greatest  medical 
philosophers  to  the  dust  of  his  fellows ;  especially  as  our  profession  is 
not  rich  in  associations  with  Westminster  Abbey.  Mead,  Friend,  and 
Baillie — with  the  exception  of  Buchan,  of  '  Domestic  Medicine '  renown — 
were  the  only  medical  men,  before  Hunter,  entombed  within  its  pre- 
cincts. When  the  service  was  over  the  procession  was  thus,  arranged, 
following  the  coffin,  which  was  carried  on  a  high  bier :  The  Dean  of 
Westminster ;  Mr.  Baillie,  a  grand  nephew  of  Hunter ;  the  Earl  of  Ducie 
and  Dr.  Clarke,  of  Cambridge,  as  trustees  of  the  Hunterian  Museum ; 
Mr.  Buckland  and  Professor  Owen  ;  the  Presidents  of  the  Colleges  of 
Physicians  and  Surgeons,  the  Council  and  Professors  of  the  College  of 
Surgeons,  the  Censors  of  the  College  of  Physicians,  the  Master  and 
Warden  of  the  Apothecaries'  Company,  the  Presidents  of  several  of  the 
learned  Societies,  the  Medical  Officers  of  London  and  Provincial  Hospitals, 
and  many  visitors.  While  the  Dead  March  in  Saul  resounded  from  the 
organ,  the  procession  proceeded  round  the  Abbey,  through  lines  of  spec- 
tators, and  returned  to  a  grave  opened  on  the  north  side  of  the  nave, 
near  the  western  end.  Here  the  coffin  was  lowered  amid  a  great  con- 
course, and  many  present  obtained  their  first  glimpse  of  it.  It  was  ex- 
tremely well  preserved.  On  a  brass  plate,  with  the  family  arms,  was 
inscribed  'John  Hunter,  Esq.,  died  16th  October,  1793,  aged  64  years.' 
Beneath   this   plate   the  College   had  had  another   affixed,   with   the   in- 


Selected  Articles^  Abstracts^  c&c.  183 

scription,  '  These  remains  were  removed  from  the  Church  of  St.  Martin- 
in-the-Fields,  by  the  Royal  College  of  Surgeons  of  England,  March  21st, 
1859.'  On  opening  the  grave  for  Hunter,  the  bones  of  Ben  Jonson  were 
exposed,  and  a  skull  was  freely  handled  about,  said  to  be  that  of  '  Rare 
Be« ';  but  we  did  not  learn  that  the  truth  of  the  story  of  the  poet  being 
buried  standing  on  his  feet  was  confirmed.  However  this  may  be,  the 
Poet  and  the  great  Surgeon,  Physiologist,  and  Naturalist  rest  at  last 
side  by  side,  close  to  Gifford,  who  rescued  Jonson's  memory  from  un- 
merited obloquy,  and  another  is  added  to  the  rich  associations  of  our 
National  Mausoleum.  In  its  aisle  and  chapels  sleep  our  kings  aud 
queens.  Elizabeth  in  the  same  sepulchre  with  her  victim,  the  Scottish 
Mary ;  the  descendants  of  Robert  Bruce  by  the  side  of  the  first  Edward ;. 
Pitt  within  a  yard  of  Fox.  ^      • 

'  "  How  peaceful  and  how  powerful  is  the  grave 
Which  hushes  all !  "  ' 


MEDICAL  TEACHERS'  COMENTIOIf. 


Louisville,  May  2,  1859. 

The  Convention  of  Medical  Teachers  was  called  under  the  following 
resolution,  adopted  at  the  Eleventh  Annual  Meeting  of  the  American 
Medical  Association,  held  at  Washington  city  last  year : 

Resolved,  That  we  recommend  to  all  the  Medical  Colleges  entitled  to  a  represent- 
ation in  this  body,  that  they  appoint  delegates,  especially  instructed  to  represent  them 
in  a  meeting  to  be  held  at  Louisville,  on  Monday,  the  day  immediately  preceding  the 
Convention  of  the  American  Medical  Association  for  the  year  1859,  at  10  o'clock  in  the 
morning,  at  such  place  as  the  Committee  of  Arrangements  shall  delegate. 

In  pursuance  of  this  resolution  the  committee  selected  Mozart  Hall  for 
the  place  of  meeting,  and  they  made  every  provision  for  the  comfort  of  the 
delegates  and  the  gentlemen  of  the  press,  each  of  the  latter  having  a  con- 
venient table,  with  the  requisite  stationery  and  a  most  luxurious  arm  chair, 
prescribed  for  his  accommodation.  This  evidence  of  attention  deserves  our 
warmest  acknowledgements. 

At  the  hour  of  10  the  Convention  was  called  to  order,  and  Prof.  Dixi 
Crosby,  of  Dartmouth  College,  Hanover,  N.  H.,  was  selected  as  chairman, 
and  Prof  George  C.  Blackman,  of  Ohio  Medical  College,  at  Cincinnati,  as 
secretary.  Prof  Crosby,  on  assuming  the  chair  said  that,  like  all  his  pre- 
decessors called  upon  to  preside  over  deliberative  bodies,  he  had  been  taken 
wholly  by  surprise,  and  should  have  declined  had  not  Dr.  Frost,  of  S.  C, 
and  Dr.  Davis,  previously  excused  themselves  from  serving.  He  could 
bring  the  Convention  no  qualification  for  the  position  except  an  earnest 
desire  to  serve  them  ;  but  this,  and  the  support  of  the  members,  he  hoped 
would  enable  him  to  meet  their  approval  and  conduct  the  important  deli- 
berations satisfactorily. 

Rev.  J.  H.  Haywood  was  then  introduced,  and  invoked  the  Divine 
supervision  over  the  proceedings  of  the  body,  in  an  earnest  and  eloquent 
prayer. 

Some  discussion  then  ensued  as  to  the  mode  of  organization,  some 
wishing  all  medical  professors  present  to  act  as  delegates,  and  others  de- 
siring that  each  college  should  have  a  unit  representation.  The  following 
resolution  was  submitted  by  Dr.  David  F.  Wright,  of  Shelby  Medical 
College : 


184  The  Peninsular  and  Independent. 

Resolved,  That  all  members  of  the  Faculties  of  Medical  Colleges  now  present 
shall  be  considered  members  of  this  Convention,  but  that  where  more  than  one  belong 
to  the  same  College  one  of  them  alone  shall  vote  in  behalf  of  that  institution. 

After  some  further  interchange  of  views  —  all  tending  to  the  same 
wish  of  full  representation  —  on  motion  of  Dr.  A.  II.  Baker,  of  Cincinnati, 
the  following  substitute  was  offered  and  adopted : 

Resolved,    That  a  committee  of  three  on  credentials  be  appointed  by  the  Chair. 

Under  this  resolution,  Prof  Crosby  selected  Drs.  Baker,  Shattuck,  and 
Haskins  the  Committee  on  Credentials,  and  the  Convention  took  half  an 
hour's  recess  for  the  registration  of  the  names  of  delegates. 

Let  us  take  advantage  of  this  syncope  in  the  proceedings  to  look 
around  upon  the  descendants  of  Galen  and  Hippocrates  now  assembled 
here.  It  is  an  important  convc^ation,  its  members  exercising  the  most 
delicate  relations  to  the  whole  humafi  family  and  being  the  custodians  of 
the  life  and  health  of  the  entire  community.  A  grave,  intelligent  body  of 
men,  apparently  proudly  conscious  of  their  high  position,  the  delegates 
represent  some  of  the  most  noted  sources  of  medical  knowledge  in  the 
country.  As  they  rise  to  address  the  Chair,  we  hear  their  names  enunciated 
by  the  clear  voice  of  the  President,  and  fmd  them  to  have  been  written 
down  in  the  book  of  professional  fame,  and  associated  with  the  prosperity 
of  the  medical  colleges  to  which  they  belong,  and  in  many  instances  add- 
ing largely  to  the  reputation  of  those  institutions.  But  few  of  them  wear 
glasses;  hardly  a  wig  or  a  toupee  is  visible  upon  a  rapid  scrutiny  of  the 
heads  of  the  Professors,  and  it  seems  to  us  that,  generallj^,  they  look  more 
hale  and  heart}''  than  practicing  physicians  usually  do.  It  may  be  that 
the  professorial  duties,  which  do  not  "  murder  sleep  "  by  unreasonable 
midnight  calls,  and  the  quiet  dignity  of  the  chairs  of  Pharmacy,  Surgery, 
Chemistry,  Obstetrics,  &c.,  are  more  congenial  to  the  physical  develop- 
ment of  phj^sicians,  than  the  hard  work,  long  rides,  tedious  walks,  and 
harrassing  cares  of  the  Doctor  of  Medicine  who  has  his  round  of  patients 
to  attend.  Be  this  as  it  may,  these  teachers  of  medicine  are  a  very  fine 
looking  body  of  men,  their  heads  show  great  intellectual  development,  and 
their  eyes  are  peculiarly  keen  and  sparkling. 

But  the  Committee  on  Credentials  have  discharged  their  duty ;  the 
Convention  is  called  to  order  again,  and  the  following  delegates  are  an- 
nounced as  in  attendance,  with  the  institutions  to  which  they  belong : 

Dartmouth  College,  New  Hampshire  —  Professor  Dixi  Crosby. 

Shelby  Medical  College.  Tenn.  —  Professor  E.  B.  Haskins,  Prof.  D.  F.  Wright. 

Missouri  Medical  College —  Professor  J.  N.  McDowell. 

St.  Louis  Medical  College  —  Professor  M.  L.  Linton. 

Medical  College  of  South  Carolina —  Professor  Henry  K.  Frost. 

Medical  College  of  Georgia,  at  Augusta  —  Prof.  H.  F.  Campbell,  Prof.  Joseph  Jones. 

Medical  Department,  University  of  ]\Iichigan  —  Prof.  Moses  Gunn. 

University  of  Louisville  —  Prof.  L.  P.  Yandell,  Prof.  L.  Powell. 

Cincinnati  College  of  Medicine  —  Professor  A.  H.  Baker. 

Lind  University,  Chicago  —  Prof.  X.  S.  Davis. 

Oglethorpe  Medical  College,  Georgia  —  Prof.  A.  G.  Thomas. 

Medical  College  of  Ohio  —  Professor  George  C.  Blackman. 

Western  Reserve  Medical  College,  Cleveland,  0.  — Prof.  G.  C  C.  Weber. 

Kentucky  School  of  Medicine  —  Prof.  M.  Goldsmith,  Prof.  G.  W.  Bayless. 

Iowa  University —  Prof.  Mcgugin. 

Medical  College  of  Memphis,  Tenn.  —  Prof.  H.  R.  Robards. 

Medical  College  of  Richmond,  Ya.  —  Prof.  B.  R.  Welford,  Prof.  L.  L.  Joynes. 

Atlanta  Medical  College,  Ga.  —  Prof.  J.  G.  Westmoreland,  Prof.  John  W.  Jones. 

Medical  Faculty  of  Harvard  University,  Boston,  Mass.  —  Prof.  Geo.  C.  Shattuck. 

Rush  Medical  College,  Chicago,  111. —  Prof.  Dan'l  Brainard,  Prof.  Joseph  W.  Freer. 

The  Convention  was  then  permanently  organised  by  the  re-election  of 
the  temporary  officers,  Prof  Crosby  humorously  remarking  that  the  dele- 


Medical  Teachers'  Conveyition.  185 

gates  were  fortunate  in  this  action,  inasmuch  as  they  would  have  no  fur- 
ther speech  in  reference  to  the  honor  conferred,  &c.  He  said  that,  until 
the  Convention  should  adopt  rules  for  its  government,  he  should  limit 
speeches  to  ten  minutes,  and  allow  no  one  to  speak  more  than  twice  on  the 
same  subject  without  permission. 

Dr.  Wright's  resolution  that  members  from  Medical  Colleges  who  are 
now  present  be  permitted  to  take  part  in  the  debates,  but  that  each  college 
have  but  one  vote,  was  again  taken  up,  considered,  and  passed. 

Dr.  N.  S.  Davis  offered  the  following,  which  was  adopted : 

Resolved,  That  a  Easiness  Committee  of  five  be  appointed  by  the  Chair  to  report 
propositions  for  the  action  of  the  Convention. 

The  Chair  appointed  Drs.  N.  S.  Davis,  Gunn,  Frost,  Shattuck,  and 
Yandell.  After  a  short  recess  to  enable  this  committee  to  report,  they 
submitted  the  following  through  Dr.  Davis,  the  chairman  : 

1.  Resolved,  That  this  Convention  recognises  the  great  advantages  to  be  derived 
from  the  action  of  the  American  Medical  Association,  in  prescribing  the  terms  and  con- 
ditions on  which  medical  degrees  shall  be  conferred  and  licenses  to  practice  medicine 
shall  be  granted  ;  and  that  an  expression  of  opinion  as  to  methods  or  j)eriods  of  instruc- 
tion from  the  American  Medical  Association  should  be  received  with  deference  and  re- 
spect, and  that  all  pains  should  be  taken  to  enforce  any  rules  and  regulations  recommended 
by  that  body. 

2.  Resolved,  That  this  Convention  earnestly  recommend  the  American  Medical  As- 
sociation to  adopt  such  measures  as  will  secure  the  efficient  practical  enforcement  of  the 
standard  of  premninary  education  adopted  at  its  organization  in  May,  1847  ;  and  that  the 
medical  colleges  will  cheerfully  receive  and  record  the  certificates  alluded  to  in  said 
standard  whenever  the  profession  generally  and  the  preceptors  will  see  that  students  aro 
properly  supplied  with  them. 

3.  Resolved,  That  no  medical  college  should  allow  any  term  of  practice  to  be  a 
substitute  for  one  course  of  lectures  in  the  requisitions  for  graduation. 

4.  Resolved,  That  Hospital  Clinical  Instruction  constitutes  a  necessary  part  of 
medical  education;  and  that  every  candidate  for  the  degree  of  Doctor  of  Medicine 
should  be  required  to  have  attended  such  instruction  regularly  for  a  period  of  not  less 
than  five  months  during  the  last  year  of  his  period  of  medical  pupilage. 

5.  Resolved,  That  every  Medical  College  should  rigidly  enforce  the  rule  requiring 
three,  full  years  of  medical  study  before  graduation,  and  that  the  diploma  of  no  Medical 
College  shall  be  recognized  which  is  known  to  violate  this  rule. 

Prof  Wright,  of  Nashville,  moved  that  the  resolutions  of  the  report 
be  considered  seriatum,  and  the  first  being  taken  up  he  spoke  at  length  in 
opposition  to  it,  giving  a  history  of  the  previous  difficulties  between  the 
American  Medical  Association  and  the  Medical  Colleges.  He  could  neither 
vote  for  such  a  resolution  nor  could  he  take  any  future  part  in  the  proceed- 
ings of  a  Convention  which  should  adopt  it. 

Prof  Brainard,  of  Chicago,  thought  this  Convention  was  asked  to  take 
a  step  fraught  with  peril  to  the  harmony  of  the  profession  and  its  best  in- 
terests ;  it  should  be  met  on  the  threshold,  and  a  solemn  protest  entered 
against  it.  This  body  did  not  represent  the  medical  colleges  of  the  country 
with  unanimity ;  New  York,  Philadelphia,  and  New  Orleans  were  not  repre- 
sented here,  and  he  must  consider  their  absence  as  a  protest  against  the  as- 
sumption of  any  power  on  the  part  of  this  body,  or  the  American  Medical 
Association,  to  dictate  the  terms  on  which  the  colleges  should  confer  their 
degree  or  receive  their  students.  The  admission  of  such  a  resolution  would 
produce  hostile  factions  both  in  the^profession  and  in  the  colleges,  and  could 
never  receive  the  sanction  of  those  who  had  independent,  chartered  rights 
to  fall  back  upon.  He  was  opposed  to  no  true  improvement  in  the  medical 
profession,  but  he  did  object  to  shutting  that  door  upon  young  men  desi- 
rous of  entering  the  profession  through  which  we  ourselves  all  had 
entered. 

Without  definite  action  on  the  resolution,  the  Convention  adjourned 
until  3  o'clock  p.  m. 


186  The  Peninsular  and  Independent. 

Afteenoon  Session. 

When  the  Convention  re-assembled,  Dr.  Bayless  offered  the  following 
amendments  to  the  first  resolution : 

1.  To  substitute  in  the  third  line  the  word  "recommending"  for 
"  prescribing." 

2.  To  strike  out  all  after  the  words  "deference  and  respect." 

A  long  discussion  ensued  on  the  resolution,  which  was  participated  in 
by  Doctors  Bayless,  Yandell,  Palmer,  McDowell,  Davis,  Brainard,  Shat- 
tuck.  Baker,  and  Wright.  The  differences  of  opinion  seemed  almost  as 
various  as  the  number  of  speeches,  and  the  Convention  was  tying  itself 
into  an  apparently  inextricable  entanglement,  when  an  Alexander  sprung 
up  in  the  person  of  Prof  L.  L.  Joynes,  of  the  Medical  College  of  Rich- 
mond, Va.,  who  offered  the  following  preamble  and  resolutions  as  a  substi- 
tute for  the  resolutions  from  the  Business  Committee: 

Whereas,  It  appears  that  a  large  proportion  of  the  Medical  Colleges  of  the 
United  States  are  unrepresented  in  this  Convention,  and  no  changes  in  the  present  system 
of  education  can  be  effectual  unless  adopted  by  the  schools  generally : 

Resolved,  That  it  is  inexpedient  at  this  time  to  take  any  action  upon  the  proposi- 
tion contained  in  the  report  presented  by  the  Special  Committee  en  Medical  Education, 
at  the  last  meeting  of  the  American  Medical  Association. 

Resolved,  That  with  the  view  of  obtaining  a  moro  general  union  in  counsel  and  in 
action,  upon  this  important  subject,  this  Convention  do  now  adjoUrn  to  meet  again  on  the 
day  preceding  the  next  annual  meeting  of  the  American  Medical  -.Association,  at  the 
place  which  may  be  agreed  upon  for  said  meeting,  and  that  the  several  Medical  Colleges 
in  the  United  States  be  requested  to  appoint  each  one  delegate  to  such  adjourned  meeting 
of  this  Convention. 

These  resolutions  were  amended,  at  the  suggestion  of  Dr.  Wright,  to 
include  the  appointment  of  a  committee  of  five,  to  take  into  consideration 
during  the  recess  the  various  matters  referred  to  in  the  resolutions,  and 
report  thereon  at  the  adjourned  meeting. 

The  vote  was  demanded  on  this  by  colleges,  and  resulted  as  follows  : 

Yeas  —  Shelby  Medical  College,  Missouri  Medical  College,  St.  Louis  Medical  Col- 
lege, Oglethorpe  Medical  College,  Ohio  Medical  College,  Western  Reserve  Medical  Col- 
lege, Kentucky  School  of  Medicine,  Medical  CoUege,  Richmond ;  Atlanta  Medical  College, 
Rush  Medical  College  —  10. 

Nays  —  Medical  College,  S.C,  Medical  College,  Ga.,  Medical  Department  Univer- 
sity, Mich.,  University  of  Louisville,  Cincinnati  College  of  Medicine,  Lind  University, 
Iowa  University,  Medical  College,  Memphis  ;  Harvard  University— 9. 

The  substitute  was  declared  adopted,  yeas  10,  nays  9,  and  so  the  Con- 
vention stood  adjourned  until  the  day  preceding  the  next  annual  meeting 
of  the  American  Medical  Association. 

The  Chairman  appointed  the  following  committee  under  the  above 
resolution :  Drs.  Yandell,  Shattuck,  Blackman,  Campbell,  and  Gunn. 


Ilarm^tnttital  i^prtm^nt* 


New  Therapeutieal  Uses  for  some  of  our  Indigenous  Plants. 

We  note  the  following  new  uses  for  some  of  our  most  valued  plants, 
which  it  may  be  worth  while  to  preserve : 

Apocynum  AndroscEmifolium  (commonly  called  Dogsbane  or  Bitter 
Root)  has  been  used  with  success  in  dyspepsia  and  kindred  diseases. 
In  small  doses  the  root  is  laxative;   in  larger  ones,  cathartic. 

Atropa  Belladonna^  in  the  form  of  a  watery  solution  of  its  extract, 
is  recommended  for  arresting  the  secretion  of  milk,  by  applying  it  to 
the  areola. 

Plantago  Major.  The  fresh  juice  of  this  plant  (Yard  Plantain)  is 
stated  to  be  a  remedy  for  the  bite  of  the  venomous  spider.  It  is  ad- 
ministered in  doses  of  from  three  to  four  ounces,  with  immediate  relief. 

AcMllcB  MillifoUum  (Common  Yarrow)  is  proposed  as  an  emmena- 
gogue. 

Lycoperdon  Giganteum.  The  smoke  of  the  burning  PufF-ball  is  stated 
to  possess  decided  ansssthetic  properties,  without  evil  results  arising 
therefrom. 

Gelseminum  Sempenirius  (tincture  of  Yellow  Jessamine)  is  used  with 
success  in  treatment  of  Gonorrhoea. 

Trillium  Penditlum  (Bethroot),  combined  with  Scutellaria  laterifolia 
(Sculcap),  in  infusion,  is  recommended  in  treatment  of  Menorrhagia. 

Oentiana  quinquiflora  (under  the  name  of  Indian  quinia).  An 
infusion  of  this  plant  is  largely  used  in  the  west,  as  an  antiperiodic,  in 
domestic  practice. 

Asclepias  tuberosa  (Pleurisy  or  White  Root)  is  highly  spoken  of  as 
a  diaphoretic,  without  causing  cerebral  disturbance  or  checking  the  se- 
cretion of  the  kidneys.     '  ^ 

Sanguinaria.  This  has  recently  been  recommended  by  Dr.  Edward 
H.  Sholl,  M.  D.,  of  Warsaw,  Alabama,  in  a  communication  to  the  Phil- 
adelphia Medical  Reporter^  as  an  application  in  treatment  of  carbuncle 
and  of  pneumonia.     He  states : 

Premising,  at  first,  the  deep  incisions,  and  the  free  use  of  the  caustic 
potash,  I  have  been  in  the  habit  of  mixing  with  the  powdered  root  a  suflS- 


188  The  Peninsular  and  Independent. 

cient  quantity  of  honey  to  make  a  semi-fluid  mass.  This  is  to  be  spread 
on  lint  or  soft  musHn,  and  applied  twice  daily  to  the  diseased  part,  proper 
care  being  used  in  removing  the  discharge.  For  the  first  few  da5^s,  morn- 
ing and  night,  a  tablespoonful  of  the  Tinct.  Sang,  should  be  given,  as  an 
alterative — an  eflPect  I  am  convinced  alwa3^s  to  be  desired  in  the  earlier 
stages  of  this  disease.  This  simple  treatment  possesses  an  undeniable  snj)e- 
riority  over  any  method  I  am  cognizant  of,  in  that  it  much  abbreviates  the 
duration  of  the  disease,  and  that  from  the  first  dressing  the  improvement 
progresses  steadily  and  rapidly  to  a  cure.  This  has  been  the  uniform  ex- 
perience of  my  own  trials  with  it,  and  of  those  to  whom  I  have  suggested 
its  use,  and  I  cordially  commend  it  to  the  Profession,  hoping  they  will  give 
it  a  careful  trial,  and  note  its  merits. 

In  its  adaptation  to  the  treatment  of  pneumonia,  which,  in  our  south- 
western country,  is  prone  to  assume  a  tj^phoid  form,  gleaning  from  a  wide 
range  of  cases,  the  treatment  of  which  has  thus  far  been  uniformly  success- 
ful, in  its  curative  agency  as  alterative,  sedative,  and  nauseant,  it  has  few 
equals,  especially  when  aided  with  the  properly-timed  administration  of 
quinine.  I  speak  of  the  disease  as  it  prevails  in  our  section  of  the  country, 
and  do  not  intend  to  embrace  the  pneumonia  of  every  latitude — simply 
that  modified  by  existing  local  causes.  In  all  cases  ushered  in  with  a 
decided  chill,  experience  has  proved  that  mercury  is  positively  injurious, 
and  here  come  into  play  the  admirable  virtues  of  Sanguinaria  as  an  alte- 
rative. The  following  formula  was  obtained  from  Dr.  Cocke,  of  Missis- 
sippi, who,  during  an  extensive  practice  of  twelve  years,  I  am  told,  was 
successful  in  his  management  of  every  case  of  pneumonia : 
R.  Tinct.  Sanguinaria,  f  3  V. 
Tinct.  opii  camph,,  f3vi. 
*  Spirit  pyroxil.,  f5ss. 

Potass,  nit.  3  i. 
Aquae,  f  3  iii. 
M.  Sig.     A  teaspoonful  every  two  hours. 

Using  it  in  this  way,  coupled  with  such  other  remedies  as  the  varia- 
tions of  the  disease  may  suggest,  I  have  been  more  than  gratified  in  its 
power  of  controlling  a  dangerous  disease.  In  spasmodic  croup,  whooping 
cough,  and  chronic  diseases  of  the  liver,  I  can,  from  experience,  recom- 
mend it  to  the  Profession  as  a  useful  and  desirable  remedy. 


New  Process  for  obtaining  Scammony  Resin. 

Prof.  Williamson,  of  University  College,  England,  has  recently  pa- 
tented a  process  for  obtaining  the  pure  resinous  extractive  matter  from 
the  imported  dried  root  of  the  plant,  which  yields  a  uniform  per- 
centage of  the  article,  and  enables  him  to  supply  it  to  the  trade, 
through  the  workers  of  the  patent,  at  a  rate  much  less  than  that 
for   which   the   best   virgin   Scammony   can  be   obtained. 

The  idea  was  suggested  by  a  manufacturer  of  Extract  of  Liquorice, 
in  Turkey  in  Asia,  who  thought  that  if  the  root  of  the  plant  was  col- 
lected at  the  proper  season,  and  dried,  that  a  suitable  process  could  be 
devised  by  which  to  extract  the  resin,  rendering  the  product  more  abun- 
dant, uniform,  and  cheaper. 

Prof  "Williamson's  process  consists  of  boiling  the  roots  first  with 
water,  and   afterwards    with    diluted   acid,  by   which    means   they  were 


Pharmaceutical  Department.  18& 

deprived  of  all  matter  soluble  in  those  menstruse,  while  the  resin  was 
left  undissolved.  The  roots  are  then  digested  with  spirit,  which  dis- 
solves out  the  resin,  and  from  this  the  spirit  is  separated  by  distilla- 
tion. 

The  physical  qualities  of  the  Scammony  thus  produced  differ  from 
that  met  with  in  commerce,  and  from  pure  virgin  Scammony.  It  is 
non- porous,  not  producing  a  lather  with  water,  and  instead  of  having 
a  musty,  or  sour,  cheese -like  odor,  possesses  an  aromatic  and  fruity 
smell,  exactly  like  the  dried,  untapped  root.  In  appearance,  when  in 
thin  layers,  it  much  resembles  the  Scammony  which  is  occasionally  seen 
in  the  small  shells  (and  regarded  as  the  purest  form  of  Scammony)^ 
being  transparent  and  of  a  yellow  color.  In  composition  it  is  very  rich 
in  resin,  being  almost  entirely  composed  of  this  matter  in  the  state 
of  a  resinous  acid. 

Dr.  A.  B.  Garrod,  of  University  College,  as  the  result  of  experi- 
ments, one  hundred  and  twenty  in  number,  is  of  opinion  that  this 
new  form  of  Scammony  is  equal  to  the  best  specimens  of  virgin  Scam- 
mony, and  to  the  resin  which  is  extracted  by  ether  from  commercial 
Scammony. 


Citrate  of  Iron  and  Strychnia. 

At  the  request  of  one  of  our  subscribers,  we  call  attention  to  this 
new  therapeutic  agent,  which  has  been  used  with  considerable  success, 
^n  some  of  the  Hospitals  of  Great  Britain,  in  cases  of  dyspepsia  of  an 
atonic  character.  It  has  been  found  of  great  benefit  in  similar  con- 
ditions, depending  upon  functional  derangement  of  the  uterus  ;  acting  in 
such  cases  as  an  emmenagogue  when  all  other  remedies  have  failed, 
and  it  has  a  powerful  effect  in  tranquilizing  the  excitement  of  the  nervous 
system.  Mr.  Charles  A.  Heinitsch,  pharmaceutist,  of  Lancaster,  Penn., 
who  has  prepared  considerable  quantities  of  this  salt,  reports  that  in  the 
hands  of  the  medical  gentlemen  of  his  place  it  has  proved  a  great  sue, 
cess  in  treatment  of  chlorosis,  especially  when  dependent  upon  mental 
emotions,  or  when  there  has  been  a  total  suppression  of  the  menses 
from  any  excitement. 

This  salt,  as  found  in  market,  usually  contains  one  part  of  Strych- 
nia to  forty-eight  parts  of  Citrate  of  Iron ;  the  dose  being  three  grains, 
which  would  give  one-sixteenth  of  a  grain  of  Strychnia  with  each. 

It  is  prescribed  with  tincture  chiretta  or  tincture  chiretta  and  fluid 
ext.  valerian.  F.  S. 


Hydrate  of  Magnesia,  an  Antidote  to  tbe  Poisonous  Effects  of  Arsenlous  Acid. 

Mr.   G.    GuERiN   proposes   to    substitute   the   hydrated  peroxide   of 
iron  by  hydrate  of  magnesia,  in  arsenical  poisoning.     This  can  be  quickly 


190  The  Peninsular  and  Independent. 

prepared  by  any  one,  and  consists  of  precipitating  the  hydrate  from  a 
solution  of  sulphate  magnesia  (Epsom  salts)  by  means  of  liquor  ammonia. 
The  hydrate  of  magnesia  is  then  washed  with  several  waters,  and  admi- 
nistered in  a  state  of  suspension  in  water. 


Pepsin  WlKC. 

Our  Philadelphia  friends  in  the  Pharmaceutical  Profession,  ever  anx- 

ous  to  take  and  keep  the  lead  in  introducing  novelties  in  Medicine,   have 

gotten  up,  recently,  a  Pepsin  Wine.     We  wonder  if  it  is  like  the  following ! 

Take  of  Starchy  Pepsin,  prepared  according  to  Messrs.  Coyisart  & 
Bourdault's  formula,  one  drachm  and  a  half ;  Distilled  Water,  six  fluid 
drachms;  y^hH^y^mQ^  fifteen  fluid  drachms;  White  Sugar,  one  ounce; 
Spirits  of  Wine  (33*^),  three  fluid  drachms.  Mix,  dissolve,  and  filter.  One 
tablespoonful  of  this  wine  contains  about  fifteen  grains  of  Pepsin,  and  may 
be  given  after  every  meal. 

[D  Union  Medicate. 

We  doubt  whether  thus  dissolving  and  masking  a  Pepsin,  assists  its 
therapeutical  powers,  and  believe  the  form  recommended  by  Berthe  (in 
pastiies),  to  be  the  best  for  its  administration.  F.  S. 


Chromic  Acid  in  Syphilitic  Vegetalions. 

Mr.  Hairon,  after  describing  the  advantages  derivable  from  the  chromic 
acid  in  certain  forms  of  the  granular  eyelid  (a  disease  of  common  occur- 
rence in  the  Belgian  army),  observes  that  the  trials  he  has  made  of  the 
acid,  as  recommended  by  Marshall  and  Heller  in  syphilitic  vegetation, 
have  been  attended  with  the  most  complete  and  rapid  success.  Moreover, 
its  application,  whether  to  these  syphilitic  vegetations  or  to  the  fungus 
granulations  of  the  conjunctiva,  is  never  attended  with  pain  or  reaction, 
notwithstanding  the  rapid  destruction  of  tissue  that  takes  place. 

Annates  d?  Occulisiigue. 


Betectioa  of  Pregnancy,  by  Ergot. 

A  correspondent  of  the  Boston  Medical  and  Surgical  Journal  recom- 
mends Ergot  for  the  above  purpose,  and  states : 

For  many  years  I  have  been  in  the  habit  of  administering  small  doses 
of  this  drLig  for  this  purpose,  and  in  my  hands  it  has  seldom  failed  of 
furnishing  the  evidence  sought.  The  specific  action  of  the  medicine  is  not 
felt  by  an  unimpregnated  womb,  while  the  gravid  uterus,  I  believe,  almost 
invariably  responds  to  its  action  by  some  uneasiness  in  the  back,  but  more 
particularly  by  pain  in  the  upper  part  of  the  thighs,  sufficiently,  to  enable 
you  to  diagnosticate  the  case  with  great  certainty.  I  have  in  many  doubt- 
ful cases  trusted  to  this  test,  and  have  very  seldom  been  disappointed  in  my 
diagnosis.  I  will  only  add  that  the  Ergot  can  be  given  with  entire  safety 
in  sufficient  quantity  to  accomplish  the  object  sought. 


CompoiiKd  Confection  of  Culiefes  and  Copaifea  with  Nitrate  of  Bismuth. 

M.   Caby,  in  the   Bulletin   Genh-al  de    Ihera'peutique.,   recommends 
the   addition   of  the  Nitrate  of  Bismuth  tp  combinations  of  Copaiba  and 


Pharmaceutical  Departinent.  191 

Cubebs,  as  it  possesses  the  power  of  neutralizing  the  irritating  efiPects 
produced  by  those  medicines  upon  the  digestive  canal. 

The  formula  employed  at  the  Hospital  of  St.  Lazare,  Paris,  consists 
of  equal  parts,  by  weight,  of  balsam  copaiba,  powdered  cubebs,  and 
subnitrate  bismuth,  flavored  with  some  aromatic  essence. 

It  is  stated  that  the  confection  is  acceptable  to  the  most  delicate 
stomach;  there  following  no  excitement,  epigastric  heat  or  diarrhoea. 
Its  medical  action  being  entirely  concentrated  upon  the  genito  -  urinary 
passages,  it  follows  that  the  desired  results  are  more  rapidly  and  easily 
obtained. 


Hypophospbate  of  Qwiuia. 

Is  proposed  as  a  new  remedy,  by  Prof  J.  Lawrence  Smith,  and  sug- 
gested by  him  as  useful  in  hectic  fever  of  phthisis,  as  a  tonic  in  the  same 
disease ;  also  in  the  various  forms  of  cachexy,  where  quinia  is  used. 

Its  solubility  in  cold  water  also  recommends  its  use  in  place  of  the  less 
soluble  salts  of  quinia,  where  the  presence  of  acids  in  extemporaneous 
solutions  is  objectionable. 

The  H3^pophosphate  of  Quinia  may  be  made,  in  a  small  way,  by  adding 
an  excess  of  recently  precipitated  Quinia  to  a  hot  solution  of  Hy|)ophos- 
phorus  acid.  Upon  cooling,  the  salt  crystallizes  in  beautiful  silky  tufts, 
resembling,  when  dry,  asbestos  in  appearance. 

It  is  very  soluble  in  hot  water,  and  in  water  at  60°  Fahr.  in  the  pro- 
portion of  one  part  to  sixty. 

\_Semi- Monthly  Medical  News. 


The  Einpioyment  of  Altealles  iu  tlie  Extriictioa  of  the  Active  Principles  of  Plants. 

DANNEgy  noticed,  in  the  treatment  of  fevers  contracted  in  the  depart- 
ments of  Landes  and  Gironde  —  those  called  paludal  or  marsh  fevers  —  that 
while  sulphate  of  quinine  failed  so  frequently,  on  the  contrary,  success 
attended  a  host  of  so-called  empirical  recipes,  in  which  cinchona  was  com- 
bined with  carbonate  of  potassa.  This  clinical  result  induced  Danne9y  to 
investigate  the  nature  of  the  action  of  the  alkaline  carbonate,  and  brought 
him  to  the  conclusion  that  the  alkalies  (potassa  or  soda)  were  the  most 
powerful  adjuvants  in  the  extraction  of  the  active  principles  contained  in 
plants.  Thus,  he  does  not  hesitate  to  propose  the  addition  of  a  small 
quantity  of  these  substances  to  water,  as  the  best  means  of  obtaining  good 
pharmaceutical  preparations. 

Cinchona  bark,  treated  by  tiiis  process,  furnishes  extracts  with  little 
taste ;  and  Dannecy  believes  that  they  will  be  preferred,  on  this  account, 
to  the  ordinary  preparations,  especially  in  the  treatment  of  children. 

The  employment  of  an  alkali  in  the  exhaustion  of  plants,  for  those 
which  contain  astringent  principles  among  their  proximate  elements,  has 
another  very  important  advantage ;  it  prevents,  during  the  evaporation  of 
the  liquid,  the  formation  of  the  substance  called  apoth&me,  which  has  been 
considered,  by  pharmacologists,  as  a  result  of  the  oxidation  of  the  ex- 
tractive principle.  The  preparation  of  the  extract  of  Kramer ia,  which 
presents  this  phenomenon  in  a  very  great  degree,  is  completely  protected 
Irom  it  by  the  addition  of  a  small  quantity  of  alkali  to  the  water  used  in  its 
preparation.     Evaporation,   then,   in  the  open  air,  does  not  furnish  the 


192  The  Peninsular  and  Independent. 

slightest  quantity  of  this  insoluble  principle,  which,  in  the  preparation  of 
the  extract  by  the  ordinary  method,  diminishes  so  notaVjly  the  proportion 
and  quality  of  the  extract  made  with  cold  water. 

After  some  experiments  made  on  nux  vomica  and  cinchona,  Danne9y 
was  induced  to  conclude  that  the  process  of  extraction  by  alkalies  furnishes 
a  ready  and  economical  method  for  the  procuring,  not  only  of  strychnia 
and  quinine,  but  also  of  other  immediate  principles,  not  yet  isolated. 

[Journal  of  Maryland  College  of  Pharmacy. 


Honey  of  Roses. 

The  following  is  from  the  pen  of  Prof  Grahame,  of  the  Maryland 
College   of  Pharmacy,    in   a   paper   read   before   the   College: 

Take  of  Red  Rose  leaves,  in  powder  (No.  50  sieve)  2  ounces. 

Clarified  Honey         .....         20  fluid  ounces. 

Diluted  Alcohol    .         .         .     '    .         .         .     sufficient  quantity. 

Oil  of  Roses 4  drops. 

Dampen  the  powder  with  the  diluted  alcohol,  and  pack  moderately  firmly 
in  a  glass  funnel  displacer;  place  over  the  surftice  a  piece  of  perforated 
filtering  paper,  and  pour  on  the  menstruum ;  set  aside  the  first  six  fluid 
drachms  of  liquid  which  pass;  continue  the  percolation  to  exhaustion 
(about  6  fluid  ounces) ;  reduce  this  bj'' water  -  bath  at  a  temperature  not 
exceeding  IGO''  F.  to  ten  fluid  drachms,  and  having  mixed  this  with  the 
portion  first  obtained,  add  the  oil  of  roses  and  mix  the  fluid  extract  thus 
made  with  the  clarified  honey. 

As  thus  prepared  Honey  of  Roses  is  highly  astringent,  and  possesses 
much  richness  of  color  and  flavor. 

Thus  formed,  it  is  an  agreeable  and  valuable  astringent  addition 
to  the  gargles  employed  in  inflammation  and  ulceration  of  the  mouth 
and  throat. 


Itcli  Ointments. 

M.  BiETT  has  made  a  series  of  experiments  at  the  St.  Louis  Hospital, 
Paris,  to  determine  what  will  cure  itch  in  the  shortest  time.     Forty-one 
different  preparations  were  employed.     Of  these  he  found  the  following  ^ 
ointment  cured  in  the  smallest  number  of  days : 

15 .    Sublimated  sulphur     ......  |j. 

Subcarbonate  of  potash      .         .         .         .         .  f  ss. 

Adeps  simplex 3  iv. 

Apply  morning  and  evening. 
Seven  days  are  required  to  destroy  the  acarus  scabei,   by  which  it  is 
produced. 

I^ .    Recent  grains  delphinium  staphisagria         .         .  §  v. 

Adeps  simplex  bul.     ......  |  viij. 

M.     Digest  twenty-four  hours  at  the  temperature  of  a  lOC^  in  a  sand 
bath,  and  strain. 

Friction  for  four  days  with  this  ointment  not  only  destroys  both  the 
insects  and  their  eggs,  but  also  completely  cures  the  eruption. 


THE 

PENINSULAR  and  INDEPENDENT 

MEDICAL  JOURNAL. 

Vol.  II.  DETROIT,  JULY,  1859.  I^o,  4. 

Original  C0mmiinirati0ns. 


ART.  XV.— Luxations  of  Hip  and  Shoulder  Joints. 

[Re  -  published  from  the  Peninsular  Journal  of  Medicine,  for  July,  1855,  with  additional 

experiments  and  observations.] 


By  Moses  Gunn,  M.  D.,  Prof,  of  Surgery  in  the  University  of  MiclL 

The  object  of  the  present  paper  is  to  elucidate  more 
fully  certain  views  relative  to  luxations  of  the  hip  and 
shoulder  joints,  which  were  contained  in  a  short  article 
originally  read  before  the  Detroit  Medical  Society,-  and 
subsequently  published  in  the  Peninsular  Journal  of 
Medicine.  An  article  on  dislocations  of  the  hip,  by  Dr. 
Markoe,  of  New  York,  published  in  the  January  No.  of 
the  Neio  York  Journal  of  Medicine,  induced  me  to  re- 
peruse  the  article  by  Dr.  Reid,  of  Rochester,  published 
in  the  Transactions  of  the  State  Medical  Society  of  New 
York;  and  I  was  pleased  to  see  how  illustrative  of  the 
views  contained  in  my  former  article  were  two  experiments, 
one  made  by  each  of  these  gentlemen.  These,  together  with 
further  experiment  on  my  own  part,  led  to  '  the  prepara- 
tion  of  the   present   paper;  in   the  construction   of  which 

Vol.  II.  -  K. 


194  The  Peninsular  and  Independent. 

I  shall  here  introduce  my  former  article,  published  in  Sep- 
tember, 1853 : 

\ 

The  views  here  advanced  I  have  taught  for  the  past  two  years 
to  the  gentlemen  composing  the  Medical  Class  in  the  University;  and 
I  shall  offer  no  apology  for  calling  the  attention  of  the  Society  for  a 
few  moments  this  evening  to  the  subject  of  Dislocations  of  the  Hip 
and  Shoulder,  and  more  particularly  to  that  form  of  the  accident,  which, 
from  the  anatomical  peculiarities  of  the  joint,  is  one  exceedingly  diffi- 
cult to  reduce  ;  and  for  the  reduction  of  which  Dr.  Reid  has  recently 
proposed  a  novel  and  efficient  mode. 

It  is  not  my  intention  to  discuss  the  question  of  priority  which 
has  been  raised  in  reference  to  this  subject,  for  there  can  be  no  doubt 
that  Dr.  Reid  arrived  at  his  conclusions  by  a  course  of  reasoning  and 
experiment,  and  that  those  conclusions  were  most  essentially  novel  to 
a  large  majority  of  the  Profession.  I  propose,  rather,  briefly  to  consider 
the  prominent  peculiarities  of  the  joint,  and  the  relation  of  the  parts  in 
a  state  of  dislocation ;  the  structures  which  oppose  the  return  of  the 
head  of  the  femur  to  the  acetabulum ;  the  manner  in  which  Dr.  Reid's 
manipulations  overcome  this  opposition ;  and,  lastly,  the  application  of 
the  principles  involved,  to  the  reduction  of  some  other  dislocations. 

The  encircling  ridge  which  gives  depth  to  the  cotyloid  cavity, 
presents  upon  its  outer  slope  a  plane,  the  inclination  of  which  varies  in 
different  parts.  At  its  posterior  portion  this  inclination  is  very  great, 
and  it  would  seem,  in  dislocation  in  this  direction,  impossible  to  return 
the  head  of  the  bone  to  the  cavity  without  lifting  it  completely  over 
the  ridge :  upwards  and  backwards  it  is  more  gradual,  and  would  seem 
to  afford  a  much  more  easily  surmountable  obstacle ;  yet  when  we  exa- 
mine the  relation  of  the  parts  in  a  dislocation  in  this  direction,  we  find 
that  applied  to  this  surface,  we  have  the  anterior  and  inferior  surface  of 
the  head  and  neck  of  the  femur,  the  rotundity  of  the  head  corresponding 
with  the  curvature  of  the  slope,  while  the  edge  of  the  acetabulum  cor- 
responds with  the  curvature  described  by  the  anterior  and  inferior  sur- 
face of  the  neck.  Although  thus  seemingly  locked  together,  compa- 
ratively slight  extension  in  the  line  of  dislocation  would  cause  the  head 
to  ride  over  the  edge  of  the  cavity,  were  it  not  bound  down  in  this 
position  by  the  surrounding  tissues.  Which  particular  tissue  constitutes 
these  bonds  is  an  important  question  to  him  who  seeks  to  relax  them. 
Dr.  Reid,  in  common  with  the  Profession  generally,  considers  the  muscles 
the  agents  which  thus  oppose  our  efforts  at  reduction,  and  his  manipu- 
lations are  conducted  with  a  view  to  relax  them,  while  the  femur,  acting 
as  a  lever,  raises  the  head  of  the  bone  clear  of  the  edge  of  the  cavity. 
With  this  same  view  we  have  the  directions  of  the  books  and  public 
teachers  to  apply  extension  and  counter -extension  slowly  and  uniformly^ 
in  order  to  tire  out  the  rebellious  muscles.      Blood-letting,    antimony. 


GuNN"  on  Jjuxations  of  Hip  and  Shoulder  Joints,       195 

^nd  the  hot  bath  are  also  called  in  to  aid  in  this  laudable  crusade  against 
these  wicked  organs. 

In  this  view,  I  would  respectfully  differ  with  Dr.  Reid,  the  teachers, 
books,  and  Profession,  and  state  my  honest  belief  that  the  muscles  oppose 
our  efforts  very  little  more  than  they  do  the  progress  of  our  earth  in  its 
'orbit.  This  belief  I  have  repeatedly  verified  by  experiments  upon  the 
dead  subject,  and  the  members  of  the  Medical  Class  of  1851-2  in  the 
University  will  remember  those  conducted  before  them.  A  subject  was 
placed  upon  the  table,  the  lower  border  of  the  gluteus  maximus  was 
taised,  and  a  scalpel  carried  through  the  subjacent  muscles,  and  an  open- 
ing made  in  the  posterior  and  superior  portion  of  the  capsular  ligament. 
The  round  ligament  was  then  divided,  and  the  head  of  the  femur  lux- 
ated upon  the  dorsum  of  the  ilium.  The  usual  indications  of  this  dis- 
location were  present.  The  subject  was  placed  in  the  proper  position,  a 
tjounter  -  extending  band  applied  to  the  perinseum,  and  fixed ;  the  strength 
of  two  men  exerted  now  upon  the  extending  band,  while  endeavor  was 
inade  to  raise  the  head  of  the  bone  clear  of  the  acetabulum  with  a  jack 
towel  was  insufficient  to  reduce  the  luxation.  Reid's  method  of  manipu- 
lation readily  replaced  the  bone.  This  experiment  was  repeated  many 
times,  and  uniformly  with  the  same  result. 

As  muscular  action  could  not  have  opposed  our  efforts  and  prevented 
success  in  this  case,  the  question  naturally  presents  itself.  What  structure 
stood  between  effort  and  success  ?  *  I  answer,  The  untorn  portion  of  the 
capsular  ligament.  In  support  of  this  view,  let  us  consider  for  a  moment 
the  position  of  the  limb  at  the  instant  of  the  escape  of  the  head  from  the 
socket  during  the  process  of  dislocation.  To  do  this,  we  must  bear  in 
mind  that  force  applied  to  the  knee  or  foot  while  the  limb  is  in  a  state 
of  adduction,  constitutes  the  most  frequent  cause  of  this  dislocation. 
Force  thus  applied  adducts  the  limb  still  more  powerfully  before  disloca- 
tion takes  place,  and  at  the  moment  of  the  escape  of  the  head  of  the 
bone  from  the  socket,  the  limb  is  in  a  direction  which  crosses  the  thigh 
of  the  opposite  side.  Immediately  that  the  head  of  the  bone  has  cleared 
the  edge  of  the  acetabulum,  it  settles  into  its  position  upon  the  dorsum 
of  the  ilium,  and  the  limb  assumes  the  position  and  direction  indicative 
of  the  accident.  During  the  dislodgement  of  the  bone,  the  superior 
and  posterior  portion  of  the  capsular  ligament  is  ruptured,  through  which 
the  head  protrudes ;  while  from  the  position  of  the  limb  at  the  instant 
of  protrusion,  the  anterior  and  inferior  portion  is  very  much  relaxed, 
thus  allowing  the  head  to  rise  easily  over  the  acetabulum.  As  soon 
as  the  head  settles  into  its  position  upon  the  dorsum  of  the  ilium,  the 
direction  of  the  limb  is  changed,  and  the  untorn  portion  of  the  ligament 
becomes  more  tense,  and  for  this  reason  the  head  of  the  bone  can  not 
be  readily  returned  to  its  place  till  the  limb  is  again  placed  in  a  position 

*  Dr.  Reid  would  answer,  passive  muscular  j&bres. 


196  The  Peninsular  and  Independent. 

to  relax  it.  Dr.  Reid's  method  does  this  most  efiPectually;  and  I  conceive 
that  any  other  plan  which  does  not  accomplish  this,  as  for  instance 
extension  and  counter  -  extension  by  the  pully,  or  Jarvis's  apparatus, 
in  the  usual  direction,  succeeds  only  by  lacerating  much  more  exten- 
sively, if  not  by  actually  tearing  the  ligament  completely  asunder,  be- 
fore the  head  of  the  bone  will  ride  over  the  edge  of  the  cavity. 

The  principle,  then,  I  would  seek  to  establish,  is  this — That  in 
luxations  of  the  Tiip  and  shoulder  the  untorn  2^ortion  of  the  capsular 
ligament,  dy  tinding  down  the  head  of  the  dislocated  l)07ie,  prevents  its 
ready  return  over  the  edge  of  the  cavity  to  its  pjlace  in  the  socJcet;  and 
that  this  return  can  he  easily  effected  dy  putting  the  limb  in  such  a 
position  as  will  effectually  approximate  the  two  points  of  attachment 
of  that  p)ortion  of  the  ligament  which  remains  untorn. 

This  principle  can  be  successfully  applied  to  the  reduction  of  the 
backward  luxation  of  the  femur  into  the  ischiatic  notch,  and  also  to  the 
several  luxations  of  the  shoulder.  It  has  several  times  been  my  guide 
in  the  reduction  of  the  downward  dislocation  of  the  humerus  into  the 
axilla.  The  patient  is  seated  upon  the  floor ;  an  assistant  slowly  raises 
the  arm  to  an  angle  of  forty -five  degrees  to  the  plane  upon  which 
the  patient  is  sitting ;  and  now  while  the  assistant  makes  extension  in 
this  direction,  the  surgeon  makes  pressure  with  the  hand  upon  the  top 
of  the  shoulder,  the  bone  readily  returns  to  its  place,  and  the  arm  i& 
dropped  to   the   side   and  secured  in  a  sling. 

White's  method  of  reducing  this  luxation,  which  is  figured  in 
"Druitt,"  is  essentially  the  same,  the  only  difference  being  in  the 
position  of  the  patient.  According  to  his  plan,  the  patient  lies  upon  his 
back,  the  scapula  is  fixed  by  a  counter -extending  band  applied  to  the 
top  of  the  shoulder,  or  by  the  hand  of  an  assistant,  while  "the  arm 
is  raised  from  the  side,  and  drawn  straight  up  by  the  head,  till  the 
bone  is  thus  elevated  into  the  socket."  In  either  method  it  will  be 
seen  that  the  upper  and  untorn  portion  of  the  capsular  ligament,  by 
the  elevation  of  the  arm,  is  very  much  relaxed,  thus  giving  a  latitude 
of  motion  to  the  head  which  greatly  facilitates  its  return,  and  which 
could  not  be  obtained  by  any  manipulation  in  which  this  relaxation  was 
less  perfect.  Nine -tenths  of  the  force  spent  in  extension  and  counter- 
extension  may  be  spared,  in  the  reduction  of  all  those  dislocations  in 
which,  by  alteration  of  the  position  of  the  limb,  such  relaxation  is  effected ; 
and  in  the  several  luxations  above  specified,  this  end  is  undoubtedly 
attainable. 

Further  tliought  and  experiment  upon  this  subject  have 
convinced  me  that  dislocations  of  the  hip  joint  can  not 
occur,  except  in  certain  positions,  and  these  are  positions 
of  very   great  distortion.     In  support  of  this  view,  I  would 


Gtjnn  on  Luxations  of  Hip  and  Shoulder  Joints.      197 

call  attention  to  the  great  security  against  this  accident 
provided  by  nature  in  the  anatomy  of  the  joint.  The 
great  depth  of  the  acetabulum,  surrounding  on  all  sides 
the  head  of  the  femur,  renders  its  escape  nearly,  if  not 
absolutely,  a  physical  impossibility,  so  long  as  the  legs 
are  parallel  to  each  other,  and  on  a  line  with  the  body. 
Fracture  of  some  of  the  bony  structures  of  the  joint  would 
be  the  result  of  great  violence,  in  this  position  of  the  limbs, 
but  dislocation  without  fracture,  I  apprehend,  never.  Be- 
fore dislocation  can  take  place,  the  limb  must  be  so  dis- 
torted that  the  walls  of  the  acetabulum  will  afford  no 
longer  protection  against  the  escape  of  the  head  of  the 
femur,  the  dislocating  force  throwing  the  head,  in  this 
changed  direction,  against  some  portion  of  the  capsule  of 
the  joint,  which  gives  way  before  it,  permitting  the  rup- 
ture of  the  round  ligament,  and  the  escape  of  the  bone. 
It  is  evident  that  while  the  changed  direction  of  the 
limb  throws  the  head  wholly  against  some  portion  of  the 
capsule,  the  opposite  side  of  this  capsule  must  be  re- 
laxed, and  by  its  relaxation  facilitate  the  riding  of  the 
head  over  the  edge  of  the  cotyloid  cavity.  Taking,  for 
example,  the  upward  and  backward  form  of  luxation,  in 
my  experiments,  I  have  found  it  impossible,  by  my  own 
strength,  to  produce  luxation,  even  when  the  direction 
of  the  limb  was  changed  to  that  which  distinguishes  this 
form  of  the  accident  after  it  has  occurred,  although  the 
upper  and  posterior  portion  of  the  capsule,  and  the  round 
ligament,    were   divided. 

In  the  course  of  my  instruction  during  the  last  winter, 
I  introduced  the  following  experiment :  A  fresh,  whole,  and 
muscular  subject  was  selected,  and  a  circular  incision  was 
made  around  the  middle  of  the  thigh  and  down  to  the 
bone ;  another,  from  the  tuberosity  of  the  ischium,  around 
the  inner  aspect  of  the  thigh,  and  over  the  dorsum 
of   the    ilium    to    the    point    of  commencement,    and    all 


198  The  Peninsular  and  Indepeyident. 

the  tissues  were  cleanly  removed  from  the  bone  and  capsule 
of  the  joint.  The  upper  and  posterior  half  of  the  capsule 
was  then  cut  away,  leaving  the  anterior  and  inferior  half 
whole,  and  the  round  ligament  was  divided.  In  this 
state  it  will  be  seen  that  all  tissues  were  entirely  out  of 
the  way  (and  could  neither  afPord  protection  against  dis- 
location, or  impediment  to  reduction),  except  the  ante- 
rior and  inferior  half  of  the  capsular  ligament.  I  now 
placed  the  limb  in  the  position  which  characterizes  the 
dislocation  upon  the  dorsum,  viz.,  the  knee  in  advance  of 
the  other,  and  the  foot  inverted ;  and  the  pelvis  being 
fixed,  I  attempted  to  produce  dislocation,  but  failed  to 
do  so;  and  I  believe  that  no  force,  however  great,- ap-. 
applied  to  the  knee,  would  be  sufficient  to  accomplish  the 
escape  of  the  head  of  the  bone  without  fracture  of  the 
acetabular  walls,  so  long  as  the  limb  remains  in  this  di-- 
rection ;  for  in  this  position,  the  head  presses  perpendi-^ 
cularly  against  the  superior  and  posterior  portions  of  the 
acetabular  walls.  But  on  carrying  the  limb  to  a  position 
in  which  the  thigh  crossed  that  of  the  opposite  side,  at 
a  point  just  above  its  middle,  slight  pressure  was  sufficient 
to  dislocate  the  bone ;  for  the  acetabular  walls,  in  this  po-. 
sition,  presented  to  the  head  of  the  bone  an  inclined 
plane,  while,  from  the  same  reason  of  position,  the  undi- 
vided portion  of  the  capsule  was  relaxed,  thus  permitting 
the  head  to  slide  easily  up  this  inclined  plane  and  ride 
over  the  acetabular  edge.  At  the  moment,  however,  du- 
ring which  the  head  rested  upon  the  edge  of  the  cavity, 
this  undivided  portion  of  the  cajDsule  became  tense,  re- 
laxed again  as  the  head  settled  down  upon  the  outside 
of  the  cavity,  and  upon  dropping  the  limb  down  to  the 
position  which  characterizes  this  dislocation,  it  became  again 
tense.  Efforts  at  reduction  by  extension  and  counter-ex-- 
tension  in  this  direction  were  now  made,  but  were  unsuc-. 
cessful,   for  this^  tense,    undivided    portion   of  the   cajDSula 


GuNN  on  Luxations  of  Hip  and  8houlder  Joints.      199 

bound  down  the  head  so  that  it  could  not  ride  back 
over  the  edge  of  the  acetabulum;  but,  on  carrying  the 
limb  across  the  other,  to  the  position  in  which  it  was 
at  the  moment  of  escape,  the  reduction  was  easily  ac- 
complished. 

Upon  the  limb  of  the  opposite  side,  the  experiment 
detailed  in  my  former  article  was  repeated,  and  with  the 
same  result. 

The  following  case  illustrates  also  the  practical  bearing 
of  the  principle  under  consideration :  In  February  of  the 
present  year  (1855)  I  was  called  into  the  interior  of  the  State 
to  reduce  a  dislocation  of  the  hip  of  four  days'  standing, 
which  had  resisted  the  efforts  of  two  very  efficient  profes- 
sional gentlemen.  They  had  extended  with  Jarvis's  ad- 
juster, and  practiced  Eeid's  manipulations,  but  without 
success.  Keid's  method,  they  informed  me,  only  altered 
the  form  of  luxation,  carrying  the  head  downward  and 
forward  upon  the  obturator  ligament.  The  luxation  had 
been  primarily  upon  the  dorsum,  but  upon  examination 
I  found  the  head  of  the  bone  in  the  ischiatic  notch.  I 
placed  the  patient  upon  his  back,  and  attempted  reduc- 
tion after  Eeid's  plan,  but  with  the  same  result  that  had 
attended  the  efforts  of  the  gentlemen  in  attendance.  By 
inverting  the  foot,  I  slipped  the  head  back  to  its  position 
in  the  notch,  and  repeated  my  efforts,  but  with  like  re- 
sults. I  thus  four  times  essayed  reduction,  but  succeeded 
only  in  making  the  head  travel  from  one  position  to  the 
other.  I  adopted  this  plan  with  confidence,  from  the  fact 
that  the  luxation  had  originally  been  upon  the  dorsum, 
but  failing  to  replace  the  bone,  I  applied  Jarvis's  adjus- 
ter, and  made  extension  after  the  usual  method,  and 
carried  it  to  the  extent  of  bending  the  extending  bar  to 
the  form  of  a  very  considerable  curve,  but  was  not  able 
to  reduce  the  luxation.  Opposed,  as  I  was  before,  to  vio- 
lence,   I    removed   the    instrument,    and   straightening   the 


^00  The  Peninsular  and  Independent. 

extending  bar,  resolved  to  adopt  Blundell's  obstetric 
mottOy  arte  non  vi.  After  some  deliberation,  I  armed 
the  adjuster  with  the  shoulder  fork,  flexed  the  thigh  at 
right  angles  with  the  body,  and  adducted  it ;  and  ap- 
plying the  shoulder  fork  to  the  pubis  and  ilium,  and  at- 
taching the  extending  bar  to  the  knee,  a  fcAv  turns  of  the 
instrument   elevated  the  head  into  the   socket. 

Although  Doct.  Keid  attributes  to  the  muscles  all  the 
difficulties  of  reduction,  he  is  explicit  upon  the  fact  that 
it  is  not  muscular  activity  which  opposes  our  efforts,  and 
points  triumphantly  to  the  ease  with  which  muscular  con- 
traction is  overcome  in  fractures  of  the  neck  and  shaft 
of  the  femur.  He  conceives  that  the  muscular  tissues 
immediately  surrounding  the  joint,  are  the  means  of  bind- 
ing down  the  head  of  the  bone  in  its  new  jDosition,  thus 
preventing   reduction.     He   says : 

*'  The  true  condition  of  the  muscles  is  this :  the  six  rotator,  adduc- 
tor, and  abductor  muscles,  viz. :  the  obturator  externus,  anteriorly  ;  the 
pyriformis,  obturator  internus,  gemelli,  and  quadratus,  posteriorly;  are 
all  in  a  state  of  extreme  tension,  while  the  other  eleven  muscles,  larger 
and  smaller,  are  shortened,  and,  in  one  sense,  contracted,  but  in  another, 
and  in  fact,  they  are  relaxed  —  that  is,  in  a  recent  dislocation.  Now  it  is 
®vident,  on  the  slightest  inspection,  that  the  six  muscles  that  are  put 
upon  the  stretch,  being  in  antagonism  to  each  other  —  that  is,  the  short, 
strong  obturator  externus  anteriorly,  being  opposed  by  the  other  j&ve 
posteriorly  —  and  all  acting  at  nearly  right  angles  to  the  axis  of  the  femur, 
must  hug,  with  great  power,  the  head  of  the  bone  upon  the  dorsum, 
and  by  the  same  force,  oppose  its  ascent  over  the  brim  of  the  acetabulum, 
in  any  direct  attempt  to  replace  it  by  traction  towards  its  socket.  These 
six  muscles,  then,  so  violently  stretched,  constitute  the  real  and  only  im- 
pediments to  the  reduction  by  the  usual  mode,  and  not  the  shortened  and 
contracted  triceps  and  glutei,  as  has  always  been  believed  and  taught 
by  all  authors  and  professors  of  surgery." 

So  forcibly  impressed  is  Dr.  W.  with  the  idea  that 
^' these  six  onuscles  constitute  the  real  and  only  impedi- 
ment," that  even  in  an  experiment  of  his  own,  which  he 
details   in    his   paper,    he   fails   to   see    the   fact   which   he 


GuNN  on  Luxations  of  Hip  and  Shoulder  Joints.      201 

actually  relates,  that  there  is  another  structure  which 
forms  an  impediment.  His  experiment  was  upon  a  sub- 
ject considerably  advanced  in  decompositioUj  and  in  the 
course    of   its   relation   he    holds   the   following    language : 

"After  carefully  noting  the  relative  position  of  bone  and  muscles, 
we  made  traction  on  the  femur  downward  and  inward  over  the  sound 
limb,  as  we  are  direct^ed  by  most  authors ;  but  the  moment  the  attempt 
was  made,  the  muscles  already  named  as  being  in  a  state  of  tension 
became  more  tense,  although  all  the  muscles  about  the  joint  were  sepa- 
rated from  each  other  —  were  loose,  without  vitality,  and  almost  in  a 
state  of  decomposition,  yet  it  was  with  great  difiBculty  that  we  could 
bring  down  the  head  into  its  socket;  and  when  we  did  so,  we  carried 
away  a  part  of  the  capsular  ligament." 

It  seems  hardly  probable  that  muscles  "almost  in  a 
state  of  decomposition/'  could  form  the  "real  and  only 
impediment,"  particularly,  when  in  accomplishing  reduc- 
tion, he  '^carried  aivay  a  part  of  the  capsular  ligament." 
In   this   connection,    I   quote   from   my   first   article : 

Extension  and  counter -extension  by  the  pully,  or  Jar  vis's  appara- 
tus, in  the  usual  direction,  succeeds,  only  by  lacerating  much  more 
extensively,  if  not  actually  tearing  the  ligament  completely  asunder, 
before  the  head  of  the  bone  will  ride  over  the  edge  of  the  cavity. 

Dr.  Markoe,  who  adopts  Dr.  Eeid's  views  relative 
to  the  nature  of  the  impediment,  seems  to  have  had  a 
similar  illustration  in  one  of  his  experiments,  and,  like 
Dr.  K.,  fails  to  see  that  the  untorn  portion  of  the  cap- 
sular ligament  forms  an  "impediment."  His  experiment 
is   as  follows: 

"  I  removed  all  the  muscles,  leaving  the  capsular  ligament  only,  and 
then  endeavored  to  dislocate  the  head  of  the  bone.  I  first  tried  adduc- 
tion, and  carried  the  limb  so  forcibly  over  the  abdomen  that  the  knee 
touched  the  anterior  surface  of  the  thorax,  but  without  producing  luxa- 
tion. In  making  more  violent  efforts  in  the  same  direction,  the  cervix 
fractured,  or  rather  cracked  across  within  the  capsule,  and  soon  after  the 
ligament  itself  tore  across  at  its  superior  and  posterior  part,  just  oppo- 
site the  point  of  yielding  of  the  cervix.  The  laceration  was  directly 
across  the  ligament,  and  occupied  about  one -half  of  its  circumference. 


202  The  Peninsular  and  Independent. 

As  soon  as  this  took  place  the  dislocation  was  easily  effected.  The 
neck  of  the  femur  and  the  trochanteric  portion  of  it  were  now  seen 
to  be  kept  in  their  place  by  the  untorn  portion  of  the  capsular  liga- 
ment, which  acted  as  a  sort  of  fulcrum,  upon  which,  by  using  the 
limb  as  the  long  arm,  we  could  make  the  head,  as  the  short  arm,  move 
about  in  any  direction  upon  the  surface  of  the  dorsum  of  the  ilium." 

Does  the  untorn  portion  of  the  capsular  ligament  form 
an  impediment?  My  own  views  are,  that  it  constitutes 
the  cMef^  if  not  the  only  opposition  to  our  efforts  at 
reduction.  If  it  is  urged  that,  in  this  view,  I  am  ex- 
clusive and  ultra,  I  ask  only  that  before  such  judgment 
is  passed,  the  experiment  of  removing  all  the  tissues  about 
the  joint,    in   the   manner   detailed   above,    may   be   made. 

Thus  much  was  published  in  the  Peninsular  Journal; 
I  now  would  add  — 

That  the  practical  rule  to  be  drawn  from  the  doctrines 
here  laid  down,  is  one  which  will  apply  to  all  disloca- 
tions; but  in  those  of  the  shoulder,  and  particularly  those 
of  the  hip,  it  is  of  almost  imperative  importance.  It  is 
this:  For  the  easy  reduction  of  a  dislocation,  the  dislo- 
cated limh  should  he  placed  in  exactly  that  position  ivhich 
characterized  it  at  the  moment  of  the  escape  of  the  joint 
end  from  its  normal  position  in  the  joint.  For  instance, 
in  the  upward  and  backward  dislocation  of  the  head  of 
the  femur  upon  the  dorsum  of  the  ilium — which  almost 
invariably  occurs  from  force  applied  either  to  the  foot  or 
knee  when  the  limb  is  in  an  adducted  position,  whereby 
it  is  more  powerfully  adducted  and  carried  across  its  fel- 
low, until  the  head  forced  up  the  inclined  plane  which 
is  presented  to  it  by  the  upperward  and  backward  portion 
of  the  acetabular  walls,  and  against  the  now  tense  upper- 
ward  and  backward  portion  of  the  capsular  ligament, 
rupturing  that  ligament,  and  escaping  from  the  acetabu- 
lum, while  the  limb  is  in  this  greatly  distorted  position, — 
the  indication  is  to  carry  the  limb  across  its  fellow  until 
it   attains   the   position   in   which  it   was   at   the   moment 


GuNN  on  Luxations  of  Hip  and  Shoulder  Joints.      203 

of  escape;  the  pelvis  being  now  firmly  held  by  an  assist- 
ant, the  limb,  with  a  decided  rotation  inward,  is  easily 
lifted  into  its  place. 

This  internal  rotation,  at  the  moment  of  lifting  the 
limb  into  its  place,  is  of  great  importance,  and  is  illus- 
trated by  a  more  recent  experiment  than  those  previously 
detailed.  This  experiment  also  shows  that  though  the 
untorn  portion  of  the  ligament  constitutes,  perhaps,  the 
most  important,  it  is  not  (as  I  formerly  supposed),  the 
only  obstacle  which  we  have  to  overcome  in  reducing  this 
dislocation.  The  dense  outer  portion  of  the  fascia  lata,  in 
this  distorted  position  of  the  limb,  is  put  also  greatly  upon 
the  stretch,  thereby  pressing  firmly  down  upon  the  tro- 
chanter major,  and  causing  the  head  of  the  bone  to  hook 
closely  against  the  acetabular  walls.  Internal  rotation,  by 
depressing  the  trochanter,  relieves  this  pressure,  and  thus 
eludes  the   last  opposing  agent  to  our  efforts  at  reduction. 

The  first  experiment  illustrating  this  fact  was  made  in 
the  dissecting  rooms  of  the  University  during  the  winter 
of  1857-8,  by  a  young  gentleman  who  was  then  a  candi- 
date for  graduation,  and  is  now  Dr.  William  Bovie.  The 
experiment,  which  was  original  with  him,  does  credit  to 
his  investigating  ability  and  disposition,  and  was  as  fol- 
lows :  A  dissection  was  made,  removing  the  integument 
and  superficial  fascia,  preserving,  however,  as  far  as  pos- 
sible, the  fascia  lata  and  all  the  muscles  about  the  hip. 
The  capsular  ligament  was  completely  removed,  and  the 
round  ligament  was  divided.  A  dislocation  was  now  easily 
efi*ected  by  carrying  the  limb  across  the  other,  and  push- 
ing against  the  knee.  A  far  less  degree  of  distortion,  how- 
ever, characterized  the  mal- position  of  the  joint  than  when 
the  anterior  and  inferior  portion  of  the  ligament  is  left 
attached  to  the  bones.  Extreme  efi'orts,  by  extension  and 
counter -extension,  in  the  old  way,  failed  to  efiect  reduc- 
tion;  but  both  Keid's  method^  and  that  practiced  by  my- 


,204  The  Peninsular  and  Independent. 

self^  readily  replaced  the  dislocated  bone.  Observation 
during  the  several  steps  of  both  methods  of  procedure, 
detected  the  fact  above  stated,  that  the  pressure  of  the 
outer  portion  of  the  fascia  lata  upon  the  trochanter  major, 
by  forcing  the  head  of  the  femur  down,  and  causing  it 
to  hook  against  the  ascetabular  walls,  prevented  reduction. 
Internal  rotation  completely  relieved  this  pressure,  and 
eluded  this  opposing  agent. 

During  the  past  winter,  my  prosector.  Dr.  William 
Lewitt,  made  the  following  dissections  for  me,  to  use  in 
my  class  experiments:  The  dissection  used  in  former  ex- 
periments— viz.  removing  all  the  tissues  about  the  joint, 
and  also  the  upper  and  outer  portion  of  the  capsular 
ligament,  and  severing  the  round  ligament  —  was  made 
upon  one  side;  upon  the  other,  an  incision  was  carried 
through  the  integument  and  superficial  fascia  along  the 
inferior  border  of  the  gluteus  maximus,  and  an  inter- 
muscular passage  to  the  joint  was  effected,  through  which 
all  the  capsular  ligament  was  cut  away,  and  the  round 
ligament  severed.  The  wound  was  then  closed  with  a 
continued  suture.  Here,  as  in  Dr.  Bovie's  experiments, 
there  was  no  capsular  or  round  ligament  uj)on  one  side, 
all  other  tissues  remaining  intact;  while,  upon  the  other, 
all  tissues,  except  the  anterior  and  inferior  portion  of  that 
ligament,  were  removed.  Owing  to  a  mal- formation  of 
the  joint  in  the  subject  upon  which  this  dissection  was 
made,  our  experiments  were  not  usually  satisfactory,  yet 
they  were  confirmatory  of  the  doctrines  which  are  above 
expressed.  Dislocation  could  not  be  effected  upon  either 
side,  without  very  marked  adduction,  though,  owing  to 
the  peculiar  mal -formation  of  the  joint,  less  than  the 
usual  amount  of  distortion  was  required  to  produce  dis- 
location; and  also  in  effecting  reduction,  it  was  not  neces- 
sary to  carry  the  limb  across  its  fellow  at  so  high  a  point 
as   usual.     It   was   necessary,    however,    in   order   to   effect 


GuNN  on  iMxations  of  Hip  and  Shoulder  Joints.      205 

the  reduction  witli  facility,  to  place  the  limb  in  the  same 
position  which  it  occupied  at  the  moment  of  the  escape 
of  the  head  of  the  hone  from  the  socket,  thus  confirming 
the   general   principle   above   laid   down. 

Both  limbs  were  also  luxated,  and  an  attempt  made 
to  place  them  parallel  to  one  another,  on  a  line  with  the 
trunk.  The  limb  upon  which  the  capsular  ligament  was 
dissected,  was  easily  placed  on  a  line  with  the  body,  owing 
to  the  yielding  of  the  muscular  tissue;  the  other,  upon 
which  only  the  anterior  and  inferior  portion  of  the  cap- 
sular ligament  remained,  was  brought  to  a  line  with  the 
trunk    only    by   tearing   the   ligament   completely   asunder. 

From  these  experiments  we  learn.  That  if  all  other 
tissues  are  removed,  the  undissected  portion  of  the  capsular 
ligament  will  cause  the  limb,  in  the  luxation  upon  the 
dorsum  ilii,  to  assume  the  direction  and  position  so  char- 
acteristic of  that  accident;  that  if  now  an  attempt  be 
made  to  place  the  limb  parallel  with  its  fellow,  on  a  line 
with  the  trunk,  that  attempt  will  be  unsuccessful  until 
complete  rupture  of  the  remaining  untorn  portion  of  the 
ligament  takes  place;  that  an  attempt  to  reduce  by  the 
old  method  of  extension  and  counter -extension  will  prove 
ineffectual  without  the  exercise  of  a  terrible  power,  and 
the  complete  laceration  of  the  capsular  ligament;  that  by 
placing  the  limb  in  the  position  which  it  occupied  at  the 
instant  of  escape,  reduction  is  readily  effected. 

We  learn  further,  that  if  the  ligaments  be  cut  away, 
leaving  all  other  tissues,  and  the  head  of  the  bone  be  dis- 
located upon  the  dorsum  ilii,  and  reduction  be  attempted 
by  either  Eeid's  method  or  my  own,  that  the  outer  por- 
tion of  the  facia  lata  will,  by  its  pressure  on  the  trochanter 
major,  prevent  success  until,  by  internal  rotation,  that  dif- 
ficulty is  avoided.  Hence,  we  establish  the  following  gen- 
eral rule: 

In   all  dislocations,  place   the  limb  in  just  the  position 


20G  The  Peninsular  and  Independent, 

which   characterized  it  at  the   moment  of  escape,  and   the 
reduction  will  then  be  easily  effected. 

We  further  lay  down  the   following  special  rules: 

In  the  luxation  upon  the  dorsum  ilii,  the  patient  lying 
on  his  back,  carry  the  limb  across  its  fellow  at  a  point 
corresponding  with  the  union  of  the  middle  with  the  upper 
third,  rotate  inwards,  and  the  pelvis  being  fixed  by  an 
assistant,  the  head  may  now  be  readily  be  drawn  into  its 
place. 

In  the  dislocation  into  the  obturator  foramen,  when 
extension  is  being  made  in  the  usual  way  at  the  upper 
part  of  the  thigh,  the  limb  should  be  abducted  instead  of 
adducted,  as  universally  directed;  abduction  conforms  to  the 
general  rule  laid  down  above,  and  relaxes  the  upper  and 
untorn   portion   of  the  ligament. 

In  the  forward  dislocation  upon  the  pubis,  while  exten- 
sion and  counter -extension  are  being  made  in  the  usual 
manner,  the  limb  should  be  rotated  externally;  this  relaxes 
the  posterior   and  untorn  ]3ortion  of  the   ligament. 

In  the  backward  luxation  into  the  sciatic  notch,  the 
limb  should  be  carried  across  the  opj^osite  groin,  and  ro- 
tated internally,  previous   to   any   extension  being  made. 

In  the  luxation  of  the  humeral  head  into  the  axilla, 
the  arm  should  be  drawn  upward  by  the  side  of  the 
head,  as   directed   in  my  first  article. 

In  the  forward  dislocation  upon  the  thorax,  the  arm 
should  be  rotated  externally  before  extension  is  attempted. 

In  the  luxation  backwards  upon  the  dorsum  scapulas, 
the  arm  should  be  rotated  internally  before  extension  is 
commenced. 

87  Shelby  St.,  June  10th,  1859. 


Potter  on  Feculiar  Death  of  Foetus  in  Utero.         207 


ART.  XY.  — Peculiar  Death  of  Foetus  in  Ftero. 


By  a.  0.  Potter,  M.  D. 


October  19th,  1858,  I  was  called  to  visit  Mrs.  M.  in  her 
third  confinement.  When  I  arrived  at  the  house,  the  child 
was  born.  I  found  a  retained  placenta,  which  was  readily  de- 
livered with  a  good  contraction  of  the  uterus.  The  child 
was  dead,  and,  upon  examination,  the  following  appearances 
were  presented. 

The  connections  between  the  bones  of  the  cranium  by  the 
different  sutures  were  wholly  destroyed ;  the  brain  was  softened 
and  only  needed  an  incision  through  the  integument]  for  the 
whole  contents  of  the  cranium  to  be  discharged ;  in  fact,  the 
whole  head  above  the  neck  was  in  a  state  of  perfect  decom- 
position, while  below  the  neck  the  body  presented  a  healthy 
appearance.  There  were  no  signs  or  marks  of  a  putrifactive 
process  having  been  commenced  in  either  the  hands  or  feet ; 
no  marks  of  a  change  having  been  set  up  at  the  finger  or  toe 
nails,  as  might  have  been  expected  from  the  appearance  of 
the  head  and  face. 

I  was  a  little  surprised  at  this  at  first,  and  unable  to  ac- 
count for  it,  but  when  told  the  cord  was  wound  four  times 
around  the  neck  of  the  child,  it  was  easily  accounted  for. 
The  traction  upon  the  umbilical  cord  had  cut  off  the  foetal 
circulation  in  the  brain  by  the  pressure  upon  the  jugular 
veins  and  carotid  arteries;  thus  actually  killing  the  head, 
and  leaving  it  to  soften  and  decay ;  while  the  circulation 
in  the  placenta,  umbilical  cord,  body  and  limbs  of  the  foetus 
was  kept  up,  and  carried  on  for  some  time,  in  nearly  or 
quite  a  normal  state. 

That  the  circulation  in  the  cord  and  body  of  the  foetus 
should  be  carried  on  while  there  was  pressure  and  traction 
sufficient  upon  the  cord  to  cut  off  the  circulation  to  and 
in  the  brain,  has  been  a  fact  of  no  little  interest   to  me, 


208  The  Peninsular  and  Independent. 

and  this  is  my  only  reason  for  reporting  the  case  to  the 
Journcd. 

The  child  was  one  of  nearly  or  quite  full  term,  and  no 
cause  of  its  death  can  he  given  except  the  pressure  and 
traction  of  the  cord  about  its  neck,  as  given  above. 

Mantorville,  Minn.  April  28th. 


Horton's  Meteorological  Register  for  May. 


209 


ART.  XVII.  ~  Meteorological  Register  for  Month  of  May,  1859. 

Br  L.  S.  HoRTON,  House  Physician  to  U.  S.  Marine  Hospital. 


Altitude  of  Barometer  above  the  level  of  the  sea,  697  feet.     Latitude,  42^24' N.:,  and 
Longitude,  82°58' W.  of  Greenwich. 


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Vol.  IL  — O. 


^ibliojgra^Htal  ^U0rl)f, 


A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  INFANCY 
AND  CHILDHOOD.  By  T.  H.  Tanner,  M.  D.,  F.  L.  S.,  Licentiate 
of  the  Ro3'al  College  of  Physicians ;  Late  Physician  to  the  Hos- 
pital for  Women,  etc.,  etc.  Philadelphia:  Lindsay  &  Blakiston. 
1859. 

We  don't  like  the  book.  Wc  have  no  love  for  the  class 
to  which  it  belongs  ;  and  this  is  an  example  ^^ar  excellence 
of  its  class.  The  day  has  past  when  superficial  books  are 
demanded,  or  appreciated  with  favor.  A  statement  of  the 
most  prominent  facts  of  a  subject,  even  though  it  should  be 
clear  and  concise,  no  longer  makes  up  an  acceptable  book 
in  any  dei}artment  of  science  ;  and  the  ''Practical  Treatise" 
of  Dr.  Tanner  is  nothing  more.  So  far  as  the  list  of 
diseases  of  which  it  treats  is  concerned,  it  is  very  full  and 
complete  ;  but  the  reader  can  judge  of  the  value  of  the 
"  Treatise "  when  he  is  aware  that  the  whole  subject  of 
Dentition,  including  ''disorders''  of  "first  and  second  den- 
tition "  is  disposed  of  in  eight  and  a  half  duodecimo  pages ! 
Diseases  of  the  eye  are  arranged  in  eight  sections,  as  fol- 
lows :  1.  Diseases  of  Eyelids  ;  2.  Do.  of  Conjunctivaa ;  3. 
Do.  of  Sclerotic  and  Cornea  ;  4.  Do.  of  Iris  ;  5.  Congenital 
Cataract ;  6.  Amaurosis  ;  7.  Encephaloid  Fungus  of  the  Eye- 
ball ;  8.  Strabismus.  This  little  job  is  dispatched  in  20 
pages!  "Very  mild  alterative  courses  of  mercury,  especially 
of  the  bichloride,"  are  recommended  in  encephaloid  fungus! 
This   is   the   second   production  of  its   kind  which   Dr. 


JSihlio graphical  Record.  211 

Tanner  has  furaished  us  (the  first  being  a  "Manual  of 
the  Practice  of  Medicine")  ;  and  we  repeat,  that  we  don't 
like  the  style  of  the  effort.  We  utterly  abhor  all  such 
diluted  abominations  in  medical  literature.  They  are  of 
good  use  to  no  one  :  they  are  of  absolute  injury  to  the 
student ;  and  a  properly  educated  practitioner  has  no  use 
for  them.  Let  authors  cultivate  less  ground,  and  till  it 
better ;  so  shall  our  harvests  be  more  abundant,  and  the 
quality  of  the  product  greatly  improved. 

Who  the  American  sponsor  for  the  little  candidate 
for  favor  is,  we  are  not  informed.  We  are  thankful  for  this 
at  least, — It  gives  us  some  hope  for  the  future,  to  see  that 
the  ambitious  editors  of  the  host  of  exotics  which  Phila- 
delphia produces,  are  beginning  to  show  a  better  care  as 
to  the  character  of  the  work  on  which  they  parade  their 
fair  names.  Let  this  care  increase,  until  none  but  truly 
meritorious   books   are   re-  produced   in   this   country. 

a. 


CONTRIBUTIONS  TO  OPERATIVE  SURGERY  AND  SURGICAL 
PATHOLOGY.  By  J.  M.  Carnocdan,  M.  D.,  Prof.  etc.  With 
Illustrations  drawn  from  Nature.  Part.  II.  Lindsay  &  Blakiston, 
1858. 

We  had  begun  to  apprehend  that  the  somewhat  severe 
criticisms  which  some  of  the  brethren  bestowed  upon  the  first 
number  of  the  above  named  enterprize  had  dampened  the 
ardor  which  characterized  its  incieption.  The  criticisms 
referred  to  were  natural  enough,  yet  the  title  of  the  work  is 
modest,  and  the  cases  are  interesting;  and  though  the  "get 
up "  of  the  book  is,  perhaps,  pretentious,  we  freely  con- 
fess that  we  had  much  rather  see  it  in  its  present  form 
than  in  one  less  elegant,  even  though  it  would  then  escape 
the  kind  of  criticism  which  it  has  received.  If  Prof.  Car« 
NOCHAN,  or  Prof  or  Dr.  Anybodyelse,  desires  to  lay  his 
novel,  important,  or  interesting  experience   before  the  Pro-« 


212  The  Peninsular  and  Independent. 

fession  and  the  "  rest  of  mankind/'  and  chooses  to  do  bo 
in  an  attractive  form,  is  is  certainly  his  privilege  to  do 
80 ;  and,  for  one,  we  admire  the  disposition  and  taste 
evinced.  If  Mr.  Editor  Grovtler,  or  Mr.  Reviewer  Cynic, 
curl  the  lip  and  shed  a  little  concentrated  wit,  or  even 
bitterness,  from  their  quill,  steel,  gold,  or  lead  points,  why 
that  is  their  privilege ;  and  Author,  Reviewer,  and  the 
World  are  alike  unharmed  —  perhaps  all  are  improved 
thereby.  All  such  things  go  to  make  uj)  the  sum  total  of 
affairs  human. 

The  present  number  contains  the  following  cases  : 

1.  Case   of  Exsection    of  the  entire    Una. 

2.  Remarks   on   Neuralgia   of  the  Face ;  with  a  case. 

3.  Exsection   of   the   Trunlv    of    the    Second   Branch    of    the    Fifth 

Pair   of   Nerves,    beyond   the   Ganglion    of   Meckel,    for    severe 
Neuralgia  of  the  Face;   with   three  cases. 

The  neuralgic  cases  are  of  great  interest ;  and  whatever 
difference  of  opinion  may  be  entertained  as  to  the  ex- 
pediency of  such  extreme  measures  as  those  j^racticed  by 
Prof.  Carnochan,  all  will  read  them  with  avidity,  and  not 
without  profit. 

As  a  surgeon,  we  are  glad  that  the  author  is  giving 
us  his  experience  in  just  the  manner  which  he  has  chosen, 

G. 


€trit0rial  §t^KXtmnt. 


Medical  Education  in  Chicago. 

The  leader  in  the  editorial  department  of  the  Chicago 
Journal  for  June,  is  devoted  to  a  review  of  the  "First 
Annual  Announcement  of  the  Medical  Department  of  the 
Lind  University,  at  Chicago,  111.,  1859-60/' 

As  was  easily  foreseen,  the  establishment  of  a  second 
college  in  Chicago  does  not  exert  a  harmonizing  influence ; 
and  whether  it  shall  really  tend  to  accomplish  anything  in 
the  elevation  of  the  standard  of  education,  is  yet  to  be  seen. 
The  Journal  reviews,  very  ably,  the  proposed  innovations, 
and  shows  very  conclusively  that  the  projectors  of  the  Med- 
ical Department  of  Lind  University  have  not,  in  their  pres- 
ent plan,  advanced  in  the  educational  cause.  We  do  not 
endorse  all  that  the  Journal  advances ;  for  he  assails  some 
principles  which  we  advocate,  and  which  the  New  School 
in  Chicago  fails  to  fully  carry  out. 

We  should  not  have  noticed,  however,  at  the  present 
time,  the  Chicago  struggle  for  students,  but  for  the  fact 
that  the  organ  of  the  Rush  Medical  College  takes  some 
pains  to  strike  at  the  University  of  Michigan,  while  it  deals 
a  blow  at  its  immediate  rival.  ISTor  would  we  even  then 
have  answered  the  insinuation,  had  it  been  a  candid  allu- 
sion to  a  fact ;  but  such  is  not  the  case.  The  Journal 
says : 

By  carefully  noting  this  plan,  it  will  be  seen  that  it  differs  from 
that  pursued  in  all  the  Colleges  in  the  United  States  (except  that  at  Ann 


214  The  Peninsular  and  Independent. 

Arbor,  Mich.),  in  that  it  proposes  to  make  a  fall  course  of  lectures  com- 
pose 430  lectures,  delivered  in  twenty  weeks,  instead  of  576  lectures, 
delivered  in  sixteen  weeks,  as  is  the  present  practice." 

Perhaps  the  editor  of  the  organ  of  the  Eush  Medical 
College  did  not  mean  as  much  as  the  ahove  exception 
would  indicate ;  for  he  must  have  known  that  the  University 
of  Michigan  never  held  a  less  than  six  months'  course  of 
four  lectures  per  diem;  and  that  the  six  working  days 
of  each  week  were  fully  consumed^  making  a  weekly  ag- 
gregate of  twenty-four  lectures.  The  lecture  term  is  twenty- 
six  weeks  long :  deduct  one  week  for  the  examinations,  and 
we  have  twenty- five  weeks  of  actual  lecturing,  which,  mul- 
tiplied by  the  weekly  aggregate,  twenty- four,  makes  the 
sum  of  six  hundred  lectures.  The  distinctive  features  of 
the  University  of  Michigan  are,  increased  length  of  lecture 
term  and  a  diminished  daily  number  of  lectures,  enhanced 
requirements  for  the  Doctor's  Degree,  and  free  education. 
This  is  the  policy  of  the  State  of  Michigan^  established 
by  her  Legislature  as  early  as  1836,  and  required  by  the 
organic  law  of  the  University. 

This  policy  we  have  no  disposition  to  obtrude  upon 
any  other  educational  institution.  It  works  well — excel- 
lently well — with  us  in  Michigan  ;  but  it  is  for  the  people 
of  the  other  States  to  determine  whether  it  shall  be  their 
policy  or  not.  As  an  educator,  we  have  no  disposition  to 
seek  to  establish  any  general  rule  or  law  for  other  colleges, 
as  to  length  of  term,  or  daily  number  of  lectures.  We 
sincerely  wish,  however,  that  all  colleges  could  unite  upon 
one  or  two  other  points  of  reform,  viz.,  enhanced  prelim- 
inary requirements,  and  hospital  instruction.  We  believe 
that  these  two  are  the  chief  points  to  be  considered  in 
the  proposed  reform.  Likening  medical  education  to  an 
architectural  column,  the  first  represents  the  base,  the  last 
the  capital.  The  shaft  is  represented  by  the  present  lecture 
system,   and,  we   believe,  combines   already  the   solidity  of 


Editorial  Department.  215 

the  Tuscan,  and  tlie  rich  ornaments  of  the  Corinthian  orders. 
Considered  as  a  whole,  in  this  country,  the  base  is  too 
often  defective,  and  capital  only  supplied  by  years  of  private 
practice^  Gr. 

Catawba  Brandy  as  a  Medicinal  Agent. 

The  writer,  in  a  paper  read  before  the  American  Phar- 
maceutical Association,  at  its  Seventh  Annual  Meeting  in 
September,  1858,  endeavored  to  show  that  the  product  of 
brandy  in  the  Ohio  valley  might  be  made,  by  proper  means,  a 
perfect  substitute — for  all  purposes  whatever — for  that  of 
French  manufacture. 

We  presume  it  is  admitted  by  all  that  the  only  important 
medicinal  principle  in  any  brandy  is  its  alcohol,  and  that  the 
differences  in  its  market  value  are  owing  to  equal  diiferences 
in  qualit}^  of  flavor  and  odor.  In  saying  the  above,  we  refer 
only  to  brandy  made  from  wine,  and  not  to  an  artificially 
made  article. 

With  this  preface,  we  desire  to  call  attention  to  some 
remarks  of  John  Zimmerman,  of  Cincinnati,  Ohio,  which 
are  taken  from  the  Journal  of  the  Mai^yland  College  of 
Pharmacy.  This  gentleman  having  been,  to  use  his  own 
words,  "practically  and  theoretically''  connected  with  the 
American  wine-growing  establishment  of  Nicholas  Long- 
worth  and  C.  Zimmerman,  of  Cincinnati,  for  several  years, 
any  report  from  him  upon  the  subject  is  entitled  to  credit 
and  respect.     He  states  : 

In  1851,  LoNGWOKTH  and  Zimmerman  proposed  to  buy,  from 
wine-growers,  grapes  instead  of  juice,  in  order  to  prevent  any  possible 
adulteration.  By  this  operation  two  things  were  gained,  —  first,  the 
pumice  of  the  grape,  frequently  called  the  skins  or  marc  of  the  grape ; 
and  secondly,  the  lees  or  sediment — the  latter  being  a  separated  part  of 
the  juice,  which  is  produced  during  the  fermentation.  These  two  things 
forming  the  most  necessary  materials  for  the  manufacture  of  Catawba 
brandy,  can  now  be  bought  cheap  from  the  growers. 

The  best  Catawba  brandy  will  be  produced   if  the  juice   with   the 


216  The  Peninsular  and  Independent. 

pumice  are  distilled  after  fermentation,  —  the  extractive  matter  and  the 
alcohol  produced  standing  in  a  natural  proportion  to  each  other.  But 
as  the  juice  possesses  a  high  value  for  wine,  and  even  in  the  best  years 
produces  not  more  than  from  eight  to  ten  per  cent,  of  alcohol,  brandy 
manufactured  in  this  manner  would  reach  a  price  of  ten  to  fifteen 
dollars  per  gallon.  In  order,  however,  to  do  anything  in  this  line  of 
business,  so  important  to  our  country,  cheapness  of  the  article  in 
question  was  to  be  aimed  at. 

A  trial  was  made  to  distill  the  pumice  and  lees  with  the  most 
inferior  wines:  but  this  also  did  not  give  the  desired  result;  the  raw 
material  not  producing  that  quantity  of  alcohol  which  the  rich  ex- 
tractive matter  required.  Another  difficult}'^  proved  to  be  an  obstacle 
to  this  way  of  fabrication :  the  pumice  and  lees  burning  fust  to  the 
inner  brim  of  the  still  and  giving  thus  to  the  brandy  a  fragrant  taste: 
an  observation  made  by  Professor  Wayne,  of  Cincinnati,  a  member  of 
the  American  Pharmaceutical  Association,  and  communicated  in  the 
proceedings  of  that  society  for  1855. 

Further  trials  were  made  by  mixing  pumice,  lees,  and  inferior 
kind  of  wine  in  certain  manner ;  to  which  was  added  diluted  alcohol, 
in  order  to  gain  more  alcohol  to  extract  the  pumice.  This  raw  mate- 
rial was  then  distilled  by  steam  in  a  water-bath,  and  the  result  was 
more  satisfactory.  However,  the  brandy  was  not  fi-ee  of  the  corn-fusel 
oil,  which  remained  in  consequence  of  the  fabrication  of  alcohol  from 
whisky.  This  lessens  the  value  of  the  brandy,  and  is  easily  discovered 
by  the  reagent  of  L.  Molnak,  published  it  the  Proceedings  of  the 
American  Pharmaceutical  Association  for  1858,  page  67. 

In  order  to  produce  a  price-worthy  native  grape  brandy,  and 
entirely  free  of  corn-fusel  oil,  a  great  improvement  was  made  by  adding 
to  pumice,  lees,  and  inferior  kind  of  wines,  so  much  sugar  and  water 
as  to  produce,  by  fermentation,  alcohol  in  proportion  to  the  extractive 
matter ;  by  which  process,  the  pumice  also  was  extracted.  This  alcohol 
is  indentical  to  that  contained  in  the  pumice  and  lees ;  and  distillation 
repeated  four  times  proved  entirely  successful. 

The  specimen  of  brandy  presented  on  the  occasion  of  the  last  meet- 
ing of  the  American  Pharmaceutical  Association,  in  September,  1858, 
was  manufactured  in  the   above-mentioned  way,  and  two  years  old. 

American  grape  brand}^,  if  so  manufactured,  is  equal  to  French 
grape  brandy  when  of  equal  manufacture  and  age,  possessing  the  same 
grape  oil,  —  a  produce  of  fermentation,  which  forms  by  slow  chemical 
process,  oenanthic  ether,  which  must  be  present  in  old  grape  brandy, 
and  in  which  consists  the  great  medical  value  of  this  brandy. 

Imitations  of  Catawba  brandy  are  frequently  offered  for  sale,  a 
product  of  diluted  alcohol,  essential  oil  made  from  the  pumice  of  the 
Catawba  grape,  and  coloring  matter.     Such  an  article  can  be  very  easily 


Editorial  Department.  217 

discovered  by  separating  the  corn-fusel  oil  from  the  alcohol  by  chemical 
reagents. 

The  undersigned,  therefore,  is  firmly  convinced  that  xlmerican  grape 
brand}^,  if  manufactured  as  stated  and  allowed  to  grow  old  enough,  can 
fully  be  substituted  in  the  American  Pharmacopoeia  for  the  ''^Spiritus 
Vini  Gallici.''' 

We  do  not  believe,  as  does  Mr.  Zimmerman,  that  the 
"oenanthic  ether"  of  brandy  embodies  its  great  medical 
value,  but  do  believe  that  the  distilled  product  from  Catawba 
is  capable,  under  a  thoroughly  carried  out  system  of  pro- 
gressive improvement,  of  becoming  equal,  and  indeed  supe- 
rior to  the  best  products  of  foreign  climes.  The  decided  and 
fine  boquet  of  the  Catawba  grape  promises  thus  much. 

We  were  informed  by  the  Messrs.  Zimmerman  that  for 
Pharmaceutical  ]3urposes  Catawba  brandy  can  be  furnished 
of  any  required  proof  (i.  e.  alcoholic  strength),  and  without 
color.  This  fact  renders  this  form  especially  applicable  in 
the  substitution  of  alcohol  by  it  in  the  nicer  class  of  pre- 
parations, in  which  its  superiority  of  flavor  and  odor,  over 
that  of  ordinary  alcohol,  is  desirable.  F.  S. 


EDITORIAL    COERESPOIDEIfCE. 

London,  May  26th,  1859, 
Dear  Readers  of  the  Peninsular  and  Independent : 

A  month  has  now  elapsed  since  my  arrival  in  London,  and 
within  that  time  I  have  been  so  constantly  receiving  impres- 
sions from  without,  that  I  have  had  very  little  time  for  reflection ; 
and,  excepting  the  rude  jottings  in  my  journal,  and  a  few 
letters  to  friends,  have  written  nothing.  Every  day  there  are 
some  new  objects  to  be  seen — some  new  Institution  to  visit 
—  some  new  man  to  be  heard — some  new  set  of  patients  to 
be  observed;  and  these  labors,  together  with  the  following  up 
of  the  medical  men  and  cases  I  most  wish  to  hear  and  study, 
bring  me  to  my  lodgings,  at  night,  weary  and  exhausted,  almost 
absolutely  incapable  of  anything  like   vigorous  and  consecutive 


218  The  Peninsular  and  Independent. 

thought  —  and  this  state  of  mind  becoming  now,  to  a  certain  ex- 
tent a  habit,  makes  the  task  of  writing  this  letter  for  you,  appear 
formidable,  and  causes  me  to  despair  of  its  being  well  performed. 
Indeed,  I  almost  regret  that  I  have  given  any  intimation  that  I 
would  write  for  the  Journal  until  after  returning  home,  and 
getting  into  my  accustomed  writing  -  chair,  with  my  usual  sur- 
roundings, and  then  I  might  hope  that  the  impressions  now, 
being  daily  received  would  take  some  form  of  order  — 
might  be  crystallized  upon  some  thread  of  thought,  and  not 
as  they  are  now  likely  to  be,  hastily  and  irregularly  scattered 
before   you   in   amorphous   fragments. 

It  would  be  in  vain  for  me  to  attempt,  in  a  few  pages  or 
articles,  to  give  you  my  full  impressions  of  this  great  intellectual 
and  commercial  centre  —  this  metropolis  of  the  civilized  world ; 
and  as  I  am  writing  to  medical  mea,  I  shall  attempt  to  give 
you  impressions  of  nothing  more  than  medical  matters,  and 
of  such  other  things  as  have  some  relation  to  them. 

The  geographical  situation  of  London,  and  its  general  topo- 
graphy, you  all  know.  The  names  of  many  of  its  divisions, 
squares,  streets,  public  buildings,  and  even  courts  and  lanes, 
you  are  familiar  with,  as  there  are  so  frequent  allusions  to 
them  in  the  rich  literature  which  we  enjoy,  are  proud  of,  and,  in 
its  older  portions,  in  every  sense  share  in  common  with  Eng- 
lishmen. 

The  extent  of  field  here  for  medical  observation  may  be  better 
understood  by  a  few  statements.  When  one  first  looks  about 
him  in  London,  its  busy  bustle  and  its  dingy  aspect  arrests, 
most  forcibly,  his  attention.  All  he  meets  are  intent  upon  their 
own  business,  —  not  indeed,  dashing  on  with  such  speed  as  is 
often  witnessed  in  New  York,  or  used  to  be  observed  in 
Chicago;  but  actively,  perseveringly,  unanimously,  pushing  on,  as 
though  some  Malakoft'  of  commerce  or  manufacture  was  to 
be  deliberately  stormed ;  and  he  is  at  once  convinced  that 
the  assailants  are  to  be  successful.  Whatever  may  be  the 
fate  of  individuals  in  this  rush — whoever  may  be  trodden 
down  and  crushed  out  of  existence,  —  he  sees  that  general 
success  is  inevitable.  The  moment  he  looks  up  from  the  hu- 
man tide  that  is  mingling  and  flowing  past  him,  the  sombre 
walls  seem  to  gather  around,  and  frown  down  upon  him,  as 
though  he  was   an   intruder.     The   air   is   dark    and   thick    and 


Editorial  Department.  219 

heavy.  Is  there  a  seige?  has  there  been  a  battle?  are  the 
walls  blackened  with  gunpowder,  or  only  with  coal  smoke?  Is 
he  a  prisoner  of  war?  These  are  questions  instinctively  and 
obscurely  hinted,  if  not  by  his  imagination  broadly  asked.  But 
he  soon  finds  he  is  at  liberty;  he  can  go  where  he  pleases 
' — no  hostility  is  manifested;  and  if ,  he  ventures  to  ask  a 
question  —  it  matters  not  of  whom — he  may  be  answered  in  a 
somewhat  hasty,  but  always  in  a  respectful  and  kindly  tone, 
and  he  at.  once  begins  to  hope  he  is  among  friends.  He  is 
soon  confident  they  are  not  enemies;  and  in  the  order  and 
regularity  which,  amidst  this  apparent  confusion,  he  soon  sees 
prevail,  he  feels  a  security  which  calms  all  his  fears.  He  may 
now  look  about  him  at  his  ease.  He  has  a  letter  to  deliver 
or  some  business  to  transact.  He  calls  a  "hack"  or  a  "Hansom" 
(the  latter  a  two  wheeled,  covered  vehicle,  the  driver  posted 
upon  a  high  seat  behind ),  and  rolls  av/ay,  he  knows  not 
whither,  but  along  thronging  thoroughfares,  and  between  walls 
still  dingy,  yet  perhaps  less  forbidding,  than  they  seemed  at  first. 
He  may  dash  by  a  little  "square"  filled  with  trees,  shrubs,  and 
flowers,  and  adorned  with  statues  of  some  of  those  great  men 
whom  their  country  is  proud  to  honor — or  pass  along  by  a 
spacious  "park,"  with  its  stately  trees  and  silvery  pools  and 
and  winding  paths — but  on,  on  he  goes,  again  plunging  be- 
tween the  same  dingy  walls,  and  seeing  mingle  the  same  busy 
crowd,  xlnd  now  the  most  striking  feature  of  Loudon  begins 
to  burst  upon  liim  —  viz.,  its  vastness.  He  begins  to  inquire 
is  this  interminable?  —  is  there  no  limit?  But  on  he  goes; 
and  still  he  is  surrounded  by  the  same  walls,  and  still  is  rush- 
ing on  the  same  crowd.  In  a  single  drive,  if  it  be  long  enough, 
one  may  get  some  impression  of  London's  greatness;  but  this 
impression  grows  upon  him  daily  as  he  traverses  its  many  great 
thoroughfares,  sails  upon  its  rivers,  crosses  its  bridges,  descends 
through  its  Tunnel,  penetrates  its  lanes  and  alleys,  and,  in  con- 
nection with  its  extent,  considers  the  crowded  condition  of  every 
locality — the  amount  of  property  and  business  and  life,  of  labor 
and  enjoyment,  of  crime  and  sufifering,  of  good  and  evil,  pressed 
into  every  cubic  perch  of  the  vast  area;— -I  say  cubic  perch, 
for  human  life  is  found  from  the  deepest  cellar  to  the  highest 
garret. 

Within    the    limits  of  the   Metropolis   are   embraced    about 


220  The  Peninsular  and  Independent. 

3,000,000  of  people,  consuming  daily  over  5,000  sheep,  about 
1,000  bullocks,  and  8,000  salmon,  besides  all  other  kinds  of  flesh 
and  fish.  There  are  daily  swallowed  130,000  gallons  of  malt 
liquors!  and  the  milk  of  14,000  cows.  Fifty  millions  of  gallons 
of  water  daily  flow  through  its  pipes.  A  fleet  of  more  than 
1,000  sail  is  employed  to  bring  it  coal  from  the  mines  upon 
the  island,  besides  what  is  brought  upon  the  numerous  railroads. 

Of  this  vast  population,  a  much  larger  proportion  are  in 
moderate  circumstances  than  even  in  our  large  cities;  and  more 
who  are  able  to  pay  for  medical  services  apply  to  public  insti- 
tutions for  aid,  than  among  us.  The  number  of  Hospitals  and 
Infirmaries  here  is  very  great,  and  access  is  not  difficult.  From 
these  statements  it  will  readily  be  seen  that  the  number  of  pa- 
tients obtaining  treatment  in  public  institutions  is  vast;  and  as 
all  these  institutions,  under  one  regulation  or  another,  are  open 
to  students  and  medical  men  seeking  information — all  the  cases 
being  used,  if  necessary,  for  purposes  of  instruction  —  it  will 
readily  be  understood  that  the  opportunity  of  seeing  disease  here 
must  be  commensurate  with  the  vastness  of  London  in  other 
respects.  The  physicians  and  surgeons  having  charge  of  these 
institutions  are  very  polite  to  strangers  —  certainly  to  Americans 
—  furnishing  them  every  opportunity  for  observation  they  could 
desire ;  and  yet  few  remain  here  for  any  length  of  time.  As  I 
have  not  yet  witnessed  the  opportunities  for  observation  in  Paris, 
Vienna,  Edinburgh,  and  elswhere,  where  so  many  more  resort 
for  purposes  of  study,  than  here,  it  would  be  premature  to  spec- 
ulate upon  the  cause  of  so  many  giving  such  a  brief  portion  of 
their  time  abroad  to  this  place  ;  but  certainly  it  is  not  because 
there  is  a  want  of  cases  of  interest,  or  opportunities  to  observe 
them. 

I  have  already  visited  about  twenty  hospitals  of  one  sort  or 
another — their  number  of  beds  ranging  from  100  to  700 —some 
of  the  Insane  Asylums  having  accommodations  for  many  more ; 
and  there  are  many  others  I  have  not  seen.  Connected  with  al- 
most every  hospital  is  a  department  for  out-patients,  and  in  these 
many  more  cases  are  prescribed  for  than  of  those  admitted  to 
beds.  These  patients  come  to  see  particular  physicians  or  sur- 
geons, on  certain  days  in  the  week,  are  examined  and  prescribed 
for,  and  cases  among  them  of  special  interest  are  selected  for  ope- 
rations or  other  treatment  in  the  wards.     From  these,  as  well  as 


Editor ial  Department.  221 

other  sources,  are  obtained  constant  supplies  of  cases  of  interest. 
The  leading  hospitals  have  schools  of  medicine  and  surgery  con- 
nected with  them,  the  physicians  and  surgeons  to  the  respective 
hospitals  being  professors  in  the  schools ;  such  a  thing  as  medical 
school  in  London,  without  a  hospital  attached  for  clinical  instruc- 
tion, being  unknown. 

A  few  of  the  London  hospitals  are  endowed,  supported  by 
funded  property ;  but  most  of  them  are  dependent  upon  voluntary 
subscriptions  from  benevolent  individuals;  and  appeals  through 
the  press,  and  from  the  pulpits  are  frequently  made  for  contribu- 
tions in  their  support.  With  some  of  them,  donations  of  a  certain 
amount  entitle  the  donor  to  send  into  hospital  a  patient  from 
time  to  time ;  in  other  cases,  the  governors  of  the  institution  re- 
commend patients ;  while  in  other  instances,  the  cases  to  be  ad- 
mitted are  determined  by  the  medical  officers.  Individuals  and 
governors  often  delegate  their  powers  to  the  physicians  and  sur- 
geons. 

Most  of  the  hospitals  are  general ;  i.  6.  they  [admit  different 
classes  of  cases — various  medical  and  surgical  diseases;  while 
others  are  devoted  to  specialties — such  as  diseases  of  the  chest, 
the  eye,  the  ear,  those  peculiar  to  women,  children,  &c.  The  Or- 
thopoedic  Hospital  is  established  for  the  treatment  of  deformities 
of  the  body  alone. 

Some  of  those  connected  with  the  hospitals  devote  themselves 
to  specialities,  both  in  the  wards  and  with  the  out-patients, — hav- 
ing special  days  for  seeing  a  particular  class  of  cases  ;  and  patients 
are  sent  from  one  to  another,  according  as  they  are  affected  with 
one  or  another  form  of  disease.  In  some  cases,  the  clinical  teach- 
ing is  done  by  those  engaged  in  didactic  instruction  in  the  col- 
leges, but  in  most  of  the  Hospital  Schools  a  large  jDortion  of  the 
clinical  teaching  is  done  by  those  having  no  part  in  the  didactic ; 
and  in  some  instances  special  professors  of  clinical  medicine  are  ap- 
pointed, who  give  lectures  on  elementary  clinical  subjects,  as  well 
as  upon  cases  which  occur  in  their  wards. 

There  are  two  terms  of  instruction  each  year  in  the  schools, — 
a  winter  term,  commencing  in  October  and  continuing  six  months ; 
and  a  summer  term,  commencing  near  the  close  of  the  winter 
term,  and  terminating  in  July,  continuing  about  three  months. 
During  the  winter  term,  in  most  schools,  are  taught,  didactically, 
Anatomy,  Physiology,  Chemistry,  Theory  and  Practice  of  Medicine, 


222  The  Peninsular  and  Independent. 

and  Surgery.  During  the  Bummer,  Materia  Medica,  Midwifery, 
etc..  Medical  Jurisprudence,  Comparative  Anatomy,  and  Botany ; 
while  Clinical  Medicine  and  Clinical  Surgery  (each  by  several 
teachers),  and  Clinical  Midwifery,  are  continued  throughout  both 
terms;  Practical  Anatomy,  in  its  different  branches,  being  chiefly- 
attended  to  during  the  winter  (though  Morbid  Anatomy,  as  cases 
occur,  is  continued  through  the  year),  while  Practical  Chemistry 
is  chiefly  attended  to  during  the  summer.  One  special  lecture  on 
Clinical  Medicine  and  one  on  Clinical  Surgery  is  usually  given  each 
week  throughout  both  sessions. 

Having  made  these  general  statements,  I  perhaps  can  not  do 
better  than  to  give  you  an  account  of  some  of  the  Schools  and 
Hospitals — the  men  and  the  things  connected  with  them — which  I 
have  observed.  I  shall  follow  the  order  in  which  I  happened  to 
see  them.  I  beg  to  have  it  fully  understood,  however,  that 
I  do  not  undertake  to  give  a  full  account  of  any  of  the  sixteen 
schools,  or  the  numerous  hospitals,  or  any  men  or  set  of  men  ;  I 
merely  attempt  to  state  some  of  the  things  I  have  observed,  and 
such  as  I  may  think  you  will  be  most  interested  to  know. 

I  first  visited  "  University  College  Ilospital "  and  Medical 
School.  The  chief  men  connected  with  with  this  school  and  col- 
lege are  Br.  Walshe,  Professor  of  tlie  Theory  and  Practice  of 
Medicine;  Dr.  Garrod,  of  Materia  Medica;  Dr.  Carpenter,  of 
Medical  Jurisprudence;  Dr.  Murphy,  of  Obstetrics,  &c. ;  Mr. 
Ericiison,  of  Surgery  ;  Prof.  Sharply,  of  Anatomy;  Mr.  Quain, 
of  Clinical  Surgery,  etc. ;  Wharton  Jones,  Opthalmic  Medicine, 
etc.;  Dr.  Parks,  Special  Professor  of  Clinical  Medicine;  Dr. 
Jenner,  Pathology  and  Pathological  Anatomy ;  and  Mr.  Harley, 
of  Histology,  etc. 

You  will  recognize  many  names  here  with  which  you  are  very 
familiar.  You  have  perhaps  all  read  Carpenter's  Physiology,  and 
all  ought  to  have  read  his  essay  on  Alcohol ;  many  have  studied 
Sharply  and  QuAiN's  elaborate  anatomical  works;  the  younger 
men,  Mr.  Erichson's  Surgery ;  while  others  have  read  Whar- 
ton Jones's  Opthalmic  Medicine;  and,  if  many  have  not,  I  hope 
they  will  hereafter,  study  Dr.  Walshe's  elaborate  work  on  the 
Chest. 

I  have  seen  all  these  men  at  their  work,  excepting  Professor 
Sharply,  who  is  not  now  on  duty ;  and  they  are  all  vigorous  and 
active  working  men. 


Editorial  Department.  223 

Dr.  Walshe  is  a  man  rather  under  fifty,  of  medium  size,  with 
a  very  finely  developed  brain,  of  good  quality.  I  have  been  par- 
ticularly interested  in  his  clinical  exercises  in  the  Hospital.  I 
have  never  witnessed  more  searching,  exact,  and  intelligent  ex- 
aminations of  patients,  particularly  in  all  cases  of  disease  of  the 
Chest.  Nothing  could  exceed  the  minute  care  exercised  in  physi- 
cal explorations,  and  so  far  as  I  could  judge  from  witnessing  his 
procedures,  and  hearing  his  remarks,  with  occasional  examinations 
of  particular  sounds,  he  is  unusually  discriminative  and  precise  in 
his  observations,  and  very  just  in  his  conclusions.  He  is  usually 
followed  by  from  six  to  ten  students,  among  whom,  including  his  as- 
sistants, several  are  sufficiently  advanced  to  follow  him  practically 
in  most  of  his  distinctions.  He  had  only  about  twenty  beds  in 
the  hospital  (which,  by  the  way,  is  not  a  large  one),  and  usually 
not  more  than  half  of  them  were  occupied  by  patients  requiring 
special  care,  and  not  unfrequently  an  hour  and  a  half  or  more 
were  employed  in  examining  two  or  three  cases.  A  single  case 
examined  in  that  minute  and  critical  manner,  is  more  valuable  to 
all  concerned,  than  the  largest  number  loosely  and  superficially  in- 
spected, and  prescribed  for  at  random.  Indeed,  such  methods  of 
procedure  in  the  presence  of  students  is  positively  pernicious,  en- 
couraging and  forming  in  them  the  worst  of  habits. 

Dr.  Walshe  visits  his  patients  at  the  hospital  three  times  a 
week  only,  leaving  them  the  rest  of  the  time  in  the  care  of  his  as- 
sistants. This  is  the  common  custom  with  all  the  visiting  phy- 
sicians and  surgeons  in  the  hospitals  of  London.  This  is  very  well 
in  chronic  diseases,  but  in  acute  cases  the  responsibility  must  be 
with  the  assistants.  Dr.  Walshe  dictates  the  most  minute  and 
circiim^stantial  report  of  each  of  his  cases,  carefully/  studied,  to  a 
student  acting  as  clinical  clerh,  who  writes  it  down  verbatum  as 
it  is  given  him.  Many  of  the  hospital  physicians  leave  their  clinical 
clerks  to  make  their  own  report  of  the  cases,  which  reports  are 
frequently  published  and  made  the  bases  of  clinical  lectures ;  few, 
I  should  say  now,  that  I  have  seen  here,  make  such  full,  careful 
and  reliable  clinical  reports  as  Dr.  W. 

I  have  seen  in  all  the  wards  here  a  considerable  proportion  of 
cases  of  rheumatism — more  I  think  than  are  seen  in  our  hospitals, 
or  usually  in  private  practice ;  and  a  larger  proportion  than  with 
us,  seem  to  have  heart  complications.  Pericarditis,  as  indicated 
by  the  friction  sounds,  and  in  many  cases  by  evidences  of  effusion, 


224  The  Peninsular  and  Independent. 

exists  where  no  pain  in  the  part  is  experienced  by  the  patient,  or 
scarcely  any  other  rational  symptoms  indicate  its  presence.  The 
old  fashioned  remedies  of  leeching  and  blistering  are  still  resorted 
to,  and  probably  long  will  be,  notwithstanding  the  new-fangled 
notions  taught  by  some.  General  blood-letting  is,  however,  very 
seldom  practiced  in  any  form  of  rheumatic  diseases.  Some  here 
say  they  have  less  severe  heart  complications  now,  than  when 
blood  was  drawn  more  freely.  The  alkaline  treatment  is  princi- 
pally used  in  rheumatism — the  carbonate  of  potash  being  the  arti- 
cles most  commonly  prescribed.  Nitrate  of  potash  is  often  com- 
bined with  the  carbonate ;  some  adding  oj^ium  to  these.  Some, 
however,  discard  the  alkalies  and  give  the  citric  acid,  and  others 
use  colchicum,  although  this  article  is  generally  thought  here  to 
have  much  more  effect  in  gout. 

Dr.  Walshe  has  delivered  only  one  set  clinical  lecture  this 
term,  which  one  I  had  the  pleasure  of  hearing.  It  was  uj^on  Me- 
diastinal Tumors,  and  based  upon  a  case  which  occurred  some 
time  before.  It  was  an  exceedingly  able  lecture,  philosophical  and 
discriminative — analysing  closely  all  the  symptoms,  comparing 
them  with  such  as  might  have  been  })roduced  by  other  pathologi- 
cal conditions,  and  with  which  they  might  have  been  confounded, 
<fec. ;  and  it  was  delivered  in  the  clinical  lecture  room  to  just  thir- 
teen students,  two  of  whom  were  asleep  during  most  of  the  hour. 
The  places  of  these  sleeping  ones  were  sujDplied  by  another  Ameri- 
can physician  and  myself,  so  tliat  there  was  still  an  audience  of  a 
baker's  dozen.  I  have  been  astonished,  everywhere,  to  find  the 
classes  listening  to  lectures  so  small.  There  is  only  a  dozen  at- 
tendhio*  Dr.  Jenner's  lectures  on  PatholoQ-ical  Anatomv ;  some 
fifteen  or  sixteen  Mr.  Erichson's  clinical  lecture  which  I  heard; 
and  in  the  large  school  and  hospital  of  St.  Bartholomew,  the  class- 
ical Dr.  West,  in  his  regular  course  on  Obstetrics,  is  lecturing  to 
between  thirty  and  forty ;  and  Dr.  Murphy,  in  the  same  regular 
course,  at  University  College,  is  addressing  about  half  that  num 
ber.  The  largest  class  I  have  seen  assembled  for  a  lecture  was 
at  Dr.  Garrod's,  at  University  College,  and  that  was  between 
fifty  and  sixty.  The  reason  of  this  is  to  be  found  in  the  large 
number  of  schools,  and  the  more  moderate  number  of  students 
studying  in  the  Metropolis.  The  practice  of  lecturing  to  so  few, 
gets  the  professors  in  the  habit  of  being  dull  in  their  manner.  As 
a  body,  they  are  very  much  more  prosy  than  those  I  have  been 
accustomed  to  hear  in  our  own  country. 


Editorial  Department,  225 

Dr.  Garrod  is  an  active  and  industrious  man,  and  is  on  duty  in 
the  hospital.  He  has  fewer  students  attending  in  his  ward  than  Dr. 
Walshe.  I  think,  I  have  not  seen  present  more  than  half  a 
dozen ;  and  the  average  of  those  attending  the  physicians  in  their 
wards  in  all  the  hospitals,  is  but  little  over  this  number.  The 
surgeons  are  generally  better  attended  —  their  numbers  being 
from  ten  to  twenty -five,  at  most,  except  when  there  are  opera- 
tions in  the  amphitheatres. 

Dr.  Garrod  is  engaged  in  a  work  on  Gout^  which  is  now  pass- 
ing through  the  press;  and  from  some  proof-sheets  which  I 
have  seen,  and  from  his  statements  as  to  its  contents,  I  have  no 
doubt  it  will  be  a  production  of  much  value,  becoming  a  standard 
on  the  subject.  He  has  long  been  engaged  in  investigating  the 
disease,  and  in  making  dissections  of  gouty  subjects,  dying  from 
whatever  cause,  and  in  nearly  all  such  cases,  he  has  found  deposits 
of  urate  of  soda  in  many  of  the  joints,  and  likewise  in  the  cones 
of  the  kidneys.  The  subject  of  the  book  will  be  illustrated  by 
plates,  showing  the  appearance  of  these  deposits  to  the  naked 
eye  and  under  the  microscope.  I  have  examined  many  of  the 
original  specimens  from  which  the  engravings  were  taken,  and 
know  them  to  be  true  to  nature.  Saw  one  post  -  inortem  of  a 
man  who  died  from  an  amputation,  necessitated  by  an  injury,  and 
who  had  had  several  attacks  of  gout,  and  there  were  found  such 
deposits  as  Dr.  G.  predicted,  both  in  the  cartilages  of  the  joints 
and  in  the  kidneys. 

Dr.  Gaerod  informed  me  that  his  full  course  of  lectures  on 
Materia  Medica  consisted  of  about  sixty  or  less ;  and  as  he  occu- 
pies much  of  the  time  in  chemical  and  pharmaceutical  details,  tests 
of  purity,  &c.,  he  can  do  very  little  in  the  way  of  teaching  the 
therapeutical  applications  of  medicines.  He  does  not  attempt 
much.  The  same  is  true  with  other  teachers  of  this  branch  in 
London ;  and  here,  as  in  many  other  places,  the  great  subject  of 
the  character  and  effects  of  medicinal  agents,  the  philosophy  of 
their  operations  and  applications  in  modifying  disease,  is  passed 
over  as  of  comparatively  small  consequence,  and  in  some  instances 
almost  entirely  neglected.  If  the  Science  of  Medicine  is  of  any 
use  to  mankind,  it  is  in  reference  to  the  treatment  of  their  dis- 
eases ;  and  if  therapeutical  agents  are  not  to  be  understood  and 
applied,  all  our  pathological  knowledge  may  indeed  be  interesting 
as  a  matter  of  science,  but  is  of  no  use  to  suffering  humanity.     If 

Vol.  II.  —  p. 


226  The  Peninsular  and  Independent. 

the  powers  of  many  agents  to  modify  disease  beneficially  are 
doubted,  tliis  is  an  additional  reason  for  examining  thoroughly 
those  powers,  and  scrutinizing  the  authority  on  wliich  their  claims 
rest. 

Dr.  Parks,  the  Special  Professor  of  Clinical  Medicine  in  this 
school,  is  one  of  the  most,  if  not  the  most,  animated  and  agreeable 
lecturers  I  have  heard  in  London.  I  have  heard  liim  in  two  or 
three  elementary  and  practical  prelections  on  physical  examina- 
tions in  heart  disease,  and  must  say  that,  in  matter  and  manner, 
they  were  excellent.  I  have  also  seen  him  engaged  M'ith  his  class 
in  the  wards,  pointing  out  to  them,  and  causing  them  to  listen  to, 
the  different  morbid  sounds  of  the  chest,  and  have  been  delighted 
with  his  method,  so  far  as  it  goes ;  and  with  his  zeal,  which  seems 
to  be  active  and  untiring.  Dr.  PaPvIvS  is  a  comparatively  young 
man,  and  his  health  is  not  firm,  but  should  it  continue  as  now,  he 
can  not  fail  of  being  very  useful  as  a  teacher,  and  of  attaining  to 
still  greater  eminence.  He  has  not  the  extent  and  minuteness  of 
knowledge,  and  the  grasp  of  mind  of  Dr.  Walsiie,  but  he  has 
more  than  his  animation  and  zeal,  and  exceeds  him  in  the  power 
of  communicatinoj  to  others  what  he  knows.  His  labors  are  bein<; 
bestowed  upon  a  class  of  some  fifteen,  or  a  few  more.  I  shall  re- 
member him  with  pleasure,  and  watch  his  future  course  with  in- 
terest, regarding  him,  as  I  do,  as  apparently  at  least,  the  most 
zealous  and  efficient  elementary  and  practical  teacher  it  has  been 
my  lot  to  fall  in  with  in  London. 

Dr.  Murphy,  as  many  of  you  know,  has  produced  an  ex- 
cellent book  on  Parturition,  but  his  lectures  can  not  be  char- 
acterized by  the  same  adjective.  They  are  to  be  sure  suf- 
ficiently correct  and  sound,  but  are  delivered  in  what  seemed 
to   me  a  hesitatinsr  and  dull   manner. 

Dr,  Jenner  is  a  highly  intelligent  and  industrious  man. 
His  labors  in  proving  the  essential  non- identity  of  Typhus 
and  Typhoid  Fevers,  are  an  honor,  not  only  to  himself,  but 
to  the  Profession.  His  careful  and  persevering  observations, 
his  rigid  analyses  and  accurate  deductions,  are  entitled  to  all 
praise.  He  is  lively  and  earnest  in  conversation,  but  all  these 
qualities  do  not  prevent  his  being  dull  in  the  lecture -room. 
He  has  a  subject  of  deep  interest  (he  was  dwelling  when  I  have 
heard  him  more  upon  what  might  be  called  Histological 
Pathology),  but  the   lectures   being  optional    with   students,   he 


Editorial  Department >  22*7 

attracts  a  class  of  only  a  dozen  (the  number  I  have  seen  present) ; 
and  in  this  case  I  do  not  so  much  wonder.  The  students  per- 
haps might  as  well  read  the  same  matter  from  the  books.  There 
is  nothing  in  his  manner  to  impress  the  subject  with  force  upon 
their  minds. 

Some  of  you  may  think  I  attach  too  much  importance  to 
raanner  in  lecturing  —  that  the  substance  of  the  lectures  is  the 
only  important  thing — every  thing  else  in  the  process  of  im- 
parting and  receiving  knowledge  depending  on  the  student. 
This  may  be  a  plausible,  but  is  not  a  correct  view.  The 
question  whether  medical  lectures  should  be  given  at  all,  I 
do  not  propose  here  to  enter  upon.  The  general  voice  of 
the  Profession  has  pronounced  on  this  subject,  and  if  lectures 
are  useful  at  all — if  they  have  advantages  over  reading  the 
same  matter  in  books,  it  is  because  of  the  enforcement  given 
to  the  matter  by  the  presence  and  manner  of  the  living  teacher 
—  greater  interest  being  given,  and  a  stronger  impression  is  made 
upon  the  attention  and  memory  of  the  student,  by  the  pres- 
ence and  the  associations  of  the  teacher  —  by  his  infusing,  as 
it  were,  his  own  individuality  and  energy  into  his  words. 
Manner  then  becomes  important  —  becomes  indeed  in  the  living 
teacher,  of  the  highest  importance ;  in  fact,  when  it  is  dull  and 
obscure — when  it  tails  of  possessing  emphasis  and  animation, 
the  lecture,  as  compared  with  the  book,  loses  not  only  its 
charm  but  its  value.  Manner  then,  in  a  lecturer  upon  medicine, 
as  in  a  lawyer,  a  preacher,  or  any  other  speaker  or  reader, 
is  not  only  a  matter  of  importance,  but  a  proper  subject  of 
intelligence  and  criticism.  My  observations  here  have  brought 
me  to  the  conclusion  that  the  manner  of  public  speaking  and 
reading  in  London,  not  only  in  the  medical  lecture  rooms, 
but  in  the  pulpit,  at  the  bar,  and  on  the  rostrum,  is  inferior 
to  that  in  the  United  States.  Here  it  is  comparatively  heavy, 
dull,  formal,  and  indistinct.  It  very  generally  wants  anima- 
tion and  emphasis;  and  in  the  same  cases  where  these  exist, 
there  is  apt  to  be  an  affectation  and  distortion,  which,  to  me, 
is  much  more  disageeable  than  the  dullness.  I  am  sorry  I 
can  not  write  more  favorably  in  this  particular;  but  so  it 
seems  to  me.  There  are  of  course  exceptions,  doubtless  many, 
but   they   do   not   alter   the   general  fact. 

I    have  followed    Mr.   Quain^  a  few  times    in    his   surgical 


228  T]ie  Peninsular  and  Independent. 

wards.  He  is  a  little  beyond  middle  age,  but  in  his  prime 
and  vigor,  about  medium  height,  with  large,  well  formed  head 
and  a  countenance  denoting  high  intelligence,  discrimination, 
and  energy.  He  is  rather  rapid  and  decisive,  yet  deliberate 
in   his   acts   with  his   patients. 

Mr.  Ericiison  is  younger,  with  a  brain  less  developed  in 
the  frontal  and  higher  regions.  He  is  rather  dashing  than 
deliberate  in  his  manner  with  his  patients.  He  had  heard 
nothing  of  the  plan  of  making  permanent  extension  in  frac- 
tures, hip -disease,  &c.,  by  means  of  adhesive  straps;  neither 
had  Mr.  Lawrexce.  Both  seemed  pleased  with  the  idea, 
and  said  they   would   try  it. 

I  have  heard  Mr.  Ericiison  deliver  one  set  lecture  on  Clinical 
Surgery.  It  was  upon  the  "  Causes  of  Death  after  Operations," 
an  inquiry  here  quite  "  fit  to  be  made."  The  subject  was  present- 
ed systematically  and  well.  He  is  a  much  more  energetic  and 
agreeable  lecturer  than  many  others.  He  had  evidently  prepared 
himself  with  care,  using  quite  extended,  though  by  no  means  full 
notes. 

Mr.  Wharton  Jones  is  a  small,  thin,  bent  man,  fifty  or  more, 
rather  slow  and  hesitating  in  his  manner  of  speaking,  and  in  no 
way  remarkably  impressive. 

You  will  all,  doubtless,  be  glad  to  hear  something  of  Dr.  Car- 
penter. In  person,  he  is  slightly  above  the  medium  height,  erect, 
and  rather  spare,  with  a  well- developed  head,  hair  thin  upon  the 
crown,  nose  rather  long,  and  by  no  means  thin  or  pale,  and  he  ap- 
pears to  be  some  years  less  than  fifty.  As  a  lecturer,  he  is  clear, 
direct,  nnd  distinct,  though  not  specially  felicitious  or  impressive. 
He  is,  however,  altogether  acceptable. 

Though  I  had  no  introduction  to  him,  simply  mentioning  to 
him  my  name,  locality,  and  objects,  he  has  been  exceedingly  polite, 
to  me,  and  I  am  under  many  obligations  to  him  for  several  impor- 
tant favors,  among  them  was  his  instrumentality  in  procuring  an 
invitation  to  attend  a  soiree  of  the  "  Royal  Society ^^^  at  their  spa- 
cious  and  interesting  rooms  at  Burlington- house,  where  I  had  an 
opportunity  of  seeing  a  large  body  of  the  most  learned  and  dis= 
tinguished  men  of  England,  in  literature  and  science  ;  and  a  more 
intellectual  and  dignified  set  of  men  I  have  certainly  never  seen, 
and  might  add,  scarcely  expect  to  see.  There  were  present  a  very 
large  company,  all  of  whom,  on  entering,  were  received  by  the. 


Editorial  Departinent.  229 

t^resident,  Sir  Benjamin  Beodie,  their  names  at  the  same  time 
being  announced.  Among  many  others  of  note,  there  were  pres- 
ent the  Bishops  of  Winchester,  Rypon,  Carhsle,  London,  and  Ox- 
ford ;  Sir  James  Ross,  Sir  James  Clark,  Professors  Sharply, 
Faraday,  and  Wheatstone  ;  Sir  J.Forbes,  Sir  C.  L acock,  Drs. 
Bruce,  Jones,  Watson,  and  Fuller  ;  Mr.  Fergusson,  &q.  &c. 
Various  objects  of  scientific  interest  were  exhibited  during  the 
evening,  among  them,  our  countryman  Professor  Hughes's  print- 
ing telegraph!  ;  and  an  entertainment  w^as  served  in  which  much 
coffee,  though  but  a  moderate  quantity  of  wine,  was  used.  The 
I'ooras  of  the  Royal  Society  are  quite  numerous  and  spacious,  and 
are  ornamented  with  original  portraits  and  busts  of  its  distinguish- 
ed members  of  past  times.  In  one  of  them  is  deposited  the  li- 
brary, the  herbarium  and  correspondence  of  Linn^us,  besides 
many  other  objects  of  interest. 

But  this  is  wandering  from  Dr.  Carpenter.  Though  he  has 
been  successful  as  a  teacher,  he  is  about  to  resign  his  position  as  a 
Professor  of  Medical  Jurisprudence  in  the  College,  having  been 
elected  Registrar  of  the  University  of  London — a  position  which 
will  occupy  a  considerable  portion  of  his  time,  yet  will  afford  him 
opportunities  for  pursuing  his  literary  labors,  which  he  much  de- 
sires to  do.  He  says  medical  teaching  is  so  much  divided  in  Lon- 
don, that  in  a  pecuniary  sense  it  is  not  worth  one's  time.  Others 
are  of  the  same  opinion ;  and  Mr.  Paget,  the  physiologist  and 
pathologist,  has  resigned  his  professorship  of  Physiology  in  the 
largest  medical  school  in  London  —  St.  Bartholomew — because  he 
has  too  much  practice  to  make  it  an  object  for  him  to  retain  it. 

The  University  of  London,  of  which  Dr.  Carpenter  is  the 
efficient  officer — and  the  only  one  who  devotes  any  considerable 
portion  of  his  time  to  it — is  comparatively  recent  in  its  origin,  and 
at  present  so  unique  in  its  character,  and,  withal,  so  important  in 
its  relations  to  general  and  professional  education,  that  a  brief  ac- 
count of  it  may  not  be  without  interest. 

It  was  founded  in  1836,  but  has  recently  received  a  new  char- 
ter, by  which  it  is  placed  upon  a  broader  and  more  liberal  basis 
than  formerly,  and  under  which  it  is  receiving  new  life.  Differing 
from  ordinary  Universities,  which  are  institutions  for  affording  the 
highest  grade  of  instruction  in  Arts  and  Sciences,  and  granting 
degrees  indicating  proficiency  therein,  this  corporation  is  destitute 
of   professors,    and  furnishes  no  instruction  at  all — its  functions 


230  The  Peninsular  and  Independent. 

being  simply  to  examine  for  and  grant  degrees,  allowing  its  matri- 
culants to  obtain  instruction  from  whatever  sources  they  please. 
Before  its  establishment,  there  was  no  power  in  the  Metropolis  to 
grant  degrees,  either  in  the  Arts,  in  Medicine,  Divinity,  or  in 
Law.  Those,  for  instance,  who  studied  medicine  in  London,  and 
sought  for  a  degree — aspired  to  anything  more  than  a  license  from 
the  Apothecaries'  Hall  or  the  College  of  Surgeons,  or  the  mem- 
bership of  some  Medical  Society — were  obliged  to  go  to  Oxford, 
Cambridge,  Edinburgh,  or  Dublin,  for  their  coveted  honors.  This 
corporation  was  established  to  prevent  that  necessity  ;  and,  without 
presenting  details  of  its  history,  specifying  the  changes  which  it 
has  undergone,  it  now  presents  itself  as  a  body  of  the  highest  re- 
spectability, under  the  management  of  a  Ciiancellor,  Vice -Chan- 
cellor, and  thirty -six  Fellows,  comprising  such  names  as  those  of 
Macaulay,  the  Duke  of  Devonshire,  Arxoit,  Brunell,  Fara- 
day, HoDGKiN,  Warburton,  &c.,  &c.,  witli  Lord  Granville  at 
their  head.  These  Fellows,  or  Senators  as  they  are  also  called, 
establish  rules,  appoint  examiners  in  the  various  departments  of 
Science  and  Art,  who  shall  test  the  qualifications  of  those  applying 
for  degrees, — the  University  conferring  such  as  the  applicant  may 
be  found  to  deserve.  From  the  first,  they  conferred  the  degrees  of 
Bachelor  of  Arts,  Master  of  Arts,  Bachelor  of  Laws  and  Doctor 
of  Laws,  Bachelor  of  Medicine  and  Doctor  of  Medicine,  and, 
within  the  last  few  months,  after  a  full  investigation  of  the  subject, 
taking  the  testimony  of  a  large  number  of  eminent  men,  and  in 
accordance  with  the  advancing  spirit  of  the  age,  after  overcoming 
the  servile  efforts  of  those  who  wished  to  maintain  Classical  Lite- 
rature in  its  old  and  almost  exclusive  pre  -  eminence,  they  have  es- 
tablished the  degrees  of  Bachelor  of  Science  and  Doctor  of  Sci- 
ence, requiring  of  such  only  a  very  small  amount  of  Latin  and 
Greek — intending  that  those  titles  shall  indicate  as  high  a  grade  of 
mental  cultivation — as  high  a  standard  of  accomplishment — as  the 
other  corresponding  degrees.  The  idea  for  years  acted  upon  in 
the  University  of  Michigan,  in  the  establishment,  and,  though  as 
yet,  imperfect  development  of  the  Scientific  Department,  is  now 
adopted  in  the  University  of  London,  through  the  strenuous  ef- 
forts of  men  of  the  very  highest  enlightenment,  and  who  had  suffi- 
cient independence  to  rise  above  the  influence  of  precedent,  and 


Editorial  Department,  231 

the  prejudices  of  their  education.  Upon  this  subject,  the  London 
Times^  of  May  13th,  in  a  leading  article,  somewhat  lightly,  but 
approvingly,  says — "The  chymist's  son,  who  has  never  stirred 
from  his  father's  shop  and  laboratory,  may  come  up  to  Burlington- 
house,  and  ask  for  a  degree  in  Science,  with  just  know^ledge 
enough  of  dog -Latin  and  Greek  to  be  able  to  read  and  speli 
chymical  names,  without  waiting  two  or  three  years  in  a  Gram- 
mar School,  in  the  attempt  to  construe  Virgil  and  HomerP  The 
idea  of  those  controlling  this  mattf^r  in  the  University  of  London, 
is  not  to  confer  degrees  upon  those  acquainted  with  a  single  sci- 
ence, as  Chemistry  for  instance,  being  ignorant  of  every  thing 
else,  but  they  regard  proficiency  in  scientific  knowledge,  together 
with  an  acquaintance  of  their  own  language  and  literature,  as  evi- 
dence of  as  much  cultivation,  of  as  high  a  degree  of  accomplish- 
ment, as  a  knowledge  of  the  Ancient  Classics,  and  equally — nay, 
more  than  equally — worthy  of  reception  of  University  honors. 

The  lenojth  of  this  letter  will  not  allow  me  to  2:0  into  details  of 
the  conditions  for  the  reception  of  these  degrees.  I  may  say, 
however,  that  the  standard  is  intended  to  be  high  and  the  exami- 
nations rigid.  The  great  idea  of  the  London  University  is  to  take 
the  student  as  he  is,  and  return  him  as  he  comes,  placing  its  hon- 
orable brand  upon  him,  indicating  his  quality.  If  the  young  man 
is  a  proficient  in  classical  learning,  has  a  respectable  knowledge  of 
general  literature,  mathematics,  philosophy,  &c.,  he  is  stamped 
B.  A.  If  he  is  a  proficient  in  scientific  knowledge,  and  has  a  re- 
spectable acquaintance  with  other  subjects  common  to  cultivated 
men,  he  is  stamped  B.  S.  Has  he  a  knowledge  of  the  law,  he  is 
stamped  B.  L.  or  LL.  D.  Has  he  like  knowledge  of  medicine, 
he  goes  into  the  world  with  the  mark  of  M.  B.  or  M.  D.  upon 
him.  These  titles  do  not  indicate  that  he  has  been  a  certain  num- 
ber of  terms  in  some  institution  of  learning,  but  simply  that  he 
has  a  certain  amount  of  knowledge  and  cultivation,  and  of  a  kind 
indicated  by  his  title.  The  idea  is  very  simple  and  easy  of  com- 
prehension, and  may  be  worth  contemplating. 

I  should  perhaps  add,  that  those  not  belonging  to  other  recog- 
nized institutions  are  required  to  pass  a  mild  matriculation  exami- 
nation, and  in  all  cases  for  the  first  degrees  two  examinations,  at 
different  periods,  are  required. 


232  The  Peninsular  and  Independent. 

Dr.  Carpenter,  in  his  capacity  of  Registrar  of  the  University, 
is  at  the  rooms  from  one  to  four  p.  m.,  each  day,  to  conduct  the 
general  business  of  the  corporation ;  the  rest  of  his  time  he  pro- 
poses to  devote  to  scientific  and  literary  j^ursuits.  He  does  not 
now  practice  the  profession  of  medicine. 

I  am  astonished  that  in  this  long  letter  I  have  mentioned  so 

few  of  the  very  many  interesting  medical  institutions  and  men 

of  London,  hut  every  thing   else  must  be  deferred  to  a   future 

occasion. 

Yours,  very  truly,  &c., 

A.  B.  P. 


SHttt^i  ^xixths,  libstratts,  it. 


ABSTRACTS  AND   SELECTIONS   for  the   PENINSULAR  AN»   INDEPENDENT. 

By  M.  A.  Patterson,  M.  D.,  Tecumseh. 


From  the   Virginia  Medical  Journal. 
ON  THE  COMPARATIVE  INFLUENCE  OF  THE  MALE  AND  FEMALE  PARENT 
UPON  THE  PROGENY.    By  J.  B.  Thomson,  L.  R.  C.  S..    Edin.,  Resident  Surgeon 
General  Priflon,  Perth. 

The  following  cases  appear  to  me  illustrative  of  a  very  curious 
and  not  unimportant  chapter  of  anthropology,  viz.,  "The  comparative 
influence  of  the  male  and  female  of  the  human  family  upon  their 
progeny"  —  a  subject  upon  which  very  crude  and  indefinite  notions 
are  held,  not  only  by  the  public,  but  by  members  of  our  Profession. 
It  is  a  settled  point  with  man}'-,  that  it  is  foolish  to  search  after 
any  laws  regulating  the  transmission  of  particular  textures,  features, 
and   constitutions  from  either   parent   to  the  offspring. 

While  it  is  admitted  that  we  can  found  little  upon  mere  sup- 
posed general  physical  or  psychical  resemblance,  I  think  the  method 
of  inquiry  followed  in  this  paper,  is  a  correct  one,  and  that  a  number 
of  individual  instances  of  the  transmission  of  abnormal  peculiarities 
from  parent  to  progeny  being  accumulated  and  balanced,  will  lead  to 
a  safe   and    scientific   induction. 

Mercatus,    in   his   work,     "De    Morbis    Hereditariis, ''    says    truly 
that   the  parents,  grandparents  and    great-grandparents   transmit  quality 
and  character,  form  and  structure,  proportion   and   disproportion,  or  any 
preternatural   condition   of  a  single  membrane  or  organ,  parts  or  parts. 

Of  this  statement  there  can  be  little  doubt.  We  may  go  further, 
and  affirm  that,  where  we  find  such  irregularities  and  defects  plainly 
appearing  in  one  parent,  and  re-appearing  in  any  of  the  offspring, 
such  irregularities  or  defects  are  attributable  to  the  influence  of  that 
parent.  The  order  of  causation  is  not  to  be  questioned.  And  further, 
when  striking  abnormal  conditions,  physical  or  mental,  are  transmitted 
in    families,    the    statistics    of  such   should   form   data   upon  which   to 


234  The  Peninsular  and  Independent. 

found  a  proof  whether,  and  in  what  proportion,  the  influence  of  the 
male  or  of  the  female  preponderates.  Beginning  with  physical  pecu- 
liarities of  the  external  structure,  transmitted  from  parents  to  progeny, 
let  us   examine   "the   transmission  of  the  skin   peculiarities." 

Case  I.  Ilereditary  transmission  of  wehhed  fingers. — A.  M.,  Alva. 
has  had  a  family  of  nine  children,  five  sons  and  four  daughters.  He 
himself  and  his  four  daughters  are  webbed  betwixt  the  middle  and 
ring  lingers,  or  close  -  fingered  as  their  mother  calls  it,  i.e.  the  skin 
stretches  across  and  unites  these  fingers  together.  None  of  the  sons 
have  this  peculiarity.  A.  M.'s  grandfather  had  the  same;  also  his 
mother  and  two  sons  and  one  daughter ;  his  uncle  two  daughters 
and  one  son,  this  son  having  all  the  fingers  of  both  hand  webbed 
together.  A.  M.'s  daughter  has  one  daughter  webbed  betwixt  the 
middle  and   ring   fingers  of  both   hands. 

Case  II.  Ilereditary  tramnnission  of  icehhed  fingcra  and  toen. 
—  (This  case,  from  a  recent  No.  of  the  Lancet.,  is  so  similar  to  the 
former,  that  I  make  no  apology  for  transferring  it  to  this  paper,  for 
the  sake  of  illustrating  my  argument.)  W.  S.  has  three  fingers  united 
throughout  by  skin,  viz.,  the  middle,  the  ring,  and  little  fingers  of 
both  hands.  His  mother  has  the  same,  but  Vs.  S.  is  only  one  of 
seven  children  so  malformed.  Her  uncle  (her  father's  brother)  had  the 
same,  and  her  paternal  grandfather  had  the  three  smaller  toes  on  each 
foot   similarly   united. 

Case  III.  Hereditary  transmissio-n  of  fingers  and  toe^a  partially 
webhed. — J.  B.,  Menstrie,  has  a  daughter  with  six  toes  on  each  foot, 
the  little  toe  and  its  neighbor  being  well  webbed;  also,  two  little 
fingers  on  each  hand  partially  adherent  by  skin.  J.  B.'s  great-grand- 
father had  the  same  number  of  toes,  and  two  little  fingers  on  the  left 
hand  also  partially  webbed.  No  other  member  of  this  fiimily  can  be 
traced   to   have  had   any   abnormal   physical   conformation. 

Case  IV.  Supernumerary  toes  and  fingers  welled. —  J.  R.,  Tilli- 
coultry, has  the  following  peculiarity  in  his  family,  viz.,  one  girl 
webbed  betwixt  the  little  toe  and  its  neighbor;  one  son  with  two 
little  fingers  on  each  hand  and  having  two  little  toes  on  each  foot. 
No  hereditary  trace  of  these  peculiarities  can  be  found  in  any  of  the 
ancestors  of  this  family,  unless  we  admit  the  account  of  the  mother 
as  the  true  cause.  She  says,  that  when  she  carried  this  boy  in  utero, 
she  met  with  an  accident  that  split  her  fingers  in  two,  so  that  it 
always   afterwards  looked  like  two   fingers. 

From  the  small  number  of  cases  now  set  forth  it  would  be  unsafe 
to  draw  any  strong  proofs,  lest  we  should  be  placed  in  the  category 
of  the  philosopher  in  Rasselas,  who  was  always  coming  to  conclu- 
sions without  anything  being  concluded.  But,  although  we  admit  that 
such  a  small  number  of  cases  is  not  proof  positive,  we  must  allow 
that  they  point  to  the  following  deductions: 


Selected  Articles^  Abstracts^  <bc.  235 

1.  That  the  male  parent  has  a  principal  share  in  the  transmission 
of  hereditary  skin  peculiarities  to  the  offspring. 

In  Case  T.,  we  have  a  grandfather,  a  father,  and  an  uncle  send- 
ing down  an  abnormal  condition  directly  through  the  male  line ; 
and  a  striking  resemblance  to  the  male  parent  belonged  to  all  those 
descendants  who  inherit  this  skin  peculiarity.  On  the  other  hand? 
we  have  a  gi'andmother  and  a  granddaughter  transmitting  the  same 
directly   to  their  children. 

In  Case  II.,  the  paternal  grandfather,  and  in  Case  III.  the  great- 
grandfather, was  the  original  progenitor,  to  whom  the  physical  mal- 
formations were  traced  back.  Leaving  out  No.  IV.  where  the  origin 
is  very  doubtful,  we  have  the  following  proportional  cases,  in  which 
the  immediate  influence  of  the  male  exceeds  that  of  the  female 
parents : 

Case  I. — Transmitted  immediately  by  male,  10,  female,  4 

II.  "  "  "       "        3,       "       1 

III  "  "  "       "         2,       '•        0 

15  5 

But   these   cases   point   to   another   interesting   deduction : 

2.  That  the  skin  peculiarity  in  all  these  cases  where  it  could 
be  traced  back,  had  its  origin  in  a  male  progenitor.  In  No.  I.,  it  came 
in  with  a  grandfather;  in  No.  II.  with  a  paternal  grandfather,  and  in 
No.  III.  with  a  greatgrandfather.  A  curious  question  here  arises:  Did 
the  influence  of  the  originator  of  this  malformation  extend  itself  through 
several  generations  who  bore  his  peculiar  characteristics  ?  Is  it  true> 
as  Dr.  Harvie  has  recently  asserted,  that  the  male  is  the  real  producer 
of  the  species?  Is  it  true  that  the  influence  of  the  male  (in  certain 
instances)   extends   beyond   the   first   impregnation  ? 

The  consideration  of  these  cases,  which  show  the  influence  of  the 
male  to  be  greater  than  that  of  the  female  parent  in  the  transmission 
of  skin  peculiarities,  led  me  to  look  at  the  history  of  certain  skin  dis- 
eases wich  are  hereditary,  and  the  following  instances  occurred  to  my 
recollection: 

Gcise  of  the  Porcupine  Family.  — The  original  porcupine  man,  Eb- 
Ward  Lambert,  had  six  children  and  two  grandsons,  with  the  same 
singular  skin  as  himself,  resembling,  it  is  said,  an  inumerable  com- 
pany of  warts,  of  dark  brown  color,  and  a  cylindrical  figure,  rising  to 
an  inch  in  height.  In  this  case,  the  disease  originating  in  a  male* 
continued  to  all  the  family  of  six,  and  descended  to  the  grand  children. 

Leprosy,  too,  seems  to  be  chiefly  derivable  from  the  male  parent. 
In  Dr.  Simpson's  curious  inquiries  into  the  history  of  leprosy,  we  find 
quoted  from  the  old  Burgh  Records  of  Glasgow  (1859),  "Robert 
Bogell,    son  to  Patrick  Bogel,"   both   lepers  in  that  city. 


236  The  Peninsular  and  Independent. 

The  modern  experience  of  this  malady  in  Norway,  where  it  has  go 
unaccountably  increased  of  late  jears,  has  led  to  serious  inquiry  how 
it  is  to  be  prevented.  Leprosy,  or  the  spedalkshed,  is  held  by  Drs. 
Broek  and  Danielson  to  be  purely  hereditary  ;  and  so  strong  is  the 
opinion  of  the  male  being  the  chief  propagator,  that  the  proposal 
has  not  only  been  laid  before  the  Strothing,  or  Norwegian  Parliament, 
to  prohibit  the  marriage  of  a  leper,  but  it  has  been  a  topic  of  public 
and  professional  discussion,  how  far  it  would  be  just  to  deprive  the 
male  infants  of  leprous  parents  of  the  power  of  propagation.  Ligature 
of  the  vasa  deferentia,  we  learn  has  been  seriously  contemplated  as  a 
national  measure. 

The  analogy  of  the  lower  animals  confirm  these  views  of  the  para- 
mount iniiuence  of  the  male  in  transmitting  generally  the  character  of 
the  skin  to  the  progeny.  The  spawn  of  the  salmon  being  impregnated 
with  the  male  trout,  the  skin  and  the  spots  upon  it  showed  the  charac- 
ter of  the  trout,  and  vice  versa,  the  salmon  being  the  male.  With 
birds,  generally,  the  outer  textures  follow  the  male.  With  quadrupeds, 
the  same  rule  holds.  An  intelligent  and  experienced  sheep  farmer  in' 
forms  me  that  it  is  the  practice  to  cross  the  blackfaced  sheep  on  the 
Ochils  with  the  Leicester  ram.  The  Ochil  ewes  are  blackfaced,  and 
have  horns.  The  Leicester  ram  is  not  blackfaced  and  has  no  horns. 
The  breed  follow  the  Leicester  ram,  whitefaced,  and  in  the  proportion 
of  about  86  per  cent,  have  no  horns.  A  few  years  ago,  on  the  estate 
of  Ava,  there  was  a  black  ram  with  five  horns,  two  on  either  side  and 
one  on  the  center.  The  breed  by  the  common  white  ewe  took  the  ab- 
normal character  of  the  ram,  white  a  few  exceptions.  We  know  also 
that  the  products  of  the  male  ass  by  the  mare,  and  of  the  stallion  by 
she  ass,  can  be  distinguished  by  the  skin,  having  the  distinctive  char- 
acteristics of  the  sire. 

Numerous  examples  of  this  law  must  be  well  know  to  cattle  dealers, 
and  this  subject  is  admirably  treated  by  Mr.  Okton,  of  Southerland,  in 
his  ingenious  papers  "On  the  Physiology  of  Breeding." 

We  may  safely,  I  think,  conclude  from  facts  before  us: 

L  That  in  the  lower  animals,  and  in  man  also,  the  influence  of  the 
male  is  greater  than  that  of  the  female  parent  in  the  transmission  of 
the  skin  texture  to  the  progeny. 

IL  That  the  exceptional  cases  (probably  more  in  man  than  the  lower 
animals)  lead  us  to  look  for  some  primary  or  secondary  law  presiding 
over  the  physiology  of  generation. 

I  intend  to  continue  this  inquiry  as  to  the  influence  of  the  male 
on  the  other  textures  and  organs  of  the  body,  in  a  series  of  cases  and 
notes. 


Selected  Articles^  Abstracts^  <jbc.  237 


ON  THE  OTORRHCEA  OF  YOUNG  CHILDREN. 

Otorrhcea,  or  a  discharge  or  running  from  the  ear,  consists  in 
very  many  cases  of  merely  a  chronic  inflammation  of  the  external 
passage  of  the  ear,  which  has  given  rise  to  an  increased  secretion. 
The  inflammation  is  usually  confined  to  the  external  portion  of  the 
meatus,  but  sometimes  extends  to  the  surface  of  the  membrane  of 
the  tympanum.  The  disease  is  most  frequently  observed  in  children, 
although  it  is  not  rare  in  adults.  In  the  former,  it  is  generally 
accompanied  by  a  tendency  to  glandular  engorgements,  with  symptoms 
of  general  debility ;  in  adults,  it  is  also  the  sign  of  a  depressed  con- 
dition of  health.  The  exciting  cause  may  be  a  blow  upon  the  ear,  the 
employment  of  irritating  local  applications  to  the  ear,  or  any  acute 
inflammation  of  the  lining  membrane  of  the  meatus;  but  the  most 
frequent  causes  are  scarlet  fever,  measles,  or  catarrhs.  Often  no  cause 
can  be  discovered ;  the  children  complain  of  a  slight  irritation  in  the 
ear,  which  they  seek  to  allay  by  introducing  the  finger,  or  a  little 
stick,  and  the  irritation  disappears  when  the  discharge  begins.  Some- 
times, however,  the  discharge  is  the  first  symptom  of  the  disease. 
In  the  early  stages,  the  hearing  is  only  slightly  diminished  by  the 
disease,  even  when  the  inflammation  and  swelling  extend  to  the  ex- 
ternal surface  of  the  membrane  of  the  tympanum;  but  when  the 
disease  has  existed  for  any  length  of  time,  the  membrane  itself 
participates  in  it,  and  dulness  of  hearing,  or  deafness,  ensues.  More- 
over, it  must  be  borne  in  mind  that  catarrh  of  the  meatus  and  ex- 
ternal surface  of  the  tympanum  is  often  but  a  symptom  of  irritation 
icithin  the  tymjmnum,  and  ceases  as  soon  as  this  irritation  is  re- 
moved. After  the  disease  has  existed  some  time,  there  is  often 
considerable  irritation  of  the  meatus,  amounting  at  times  to  acute 
pain,  with  occasionally  slight  haemorrhage.  E hemorrhage  is  more 
frequent,    however,    when  there   is   a   polypus   in  the   meatus. 

On  examination  of  the  meatus,  its  lining  membrane  is  found  to 
be  thicker  than  usual,  and  sometimes  so  much  so  as  to  close  the 
passage  entirely.  In  many  cases  the  membrane  is  red  and  destitute 
of  epithelium ;  on  the  other  hand,  it  is  frequently  white,  and  covered 
with  a  thick  epithelial  layer.  The  secretion  is  generally  very  foetid, 
of  various  colors,  sometimes  of  a  milk-white,  at  others  of  a  dark  slate 
color,  and  whatever  its  quantity,  color,  or  consistence,  it  never  con- 
tains flocculi,    but   when   mixed   with    w^ater,   renders   it   cloudy. 

It  need  hardly  be  said  that  polj^pus  sometimes  exists  along  with 
chronic  catarrh  of  meatus.  In  such  cases  there  is  bleeding  from  the 
ear,  and  flocculi  are  found  in  the  secretion.  The  latter  are  also 
found  when  there  is  ulceration  of  the  fibrous  tissue  of  the  mem- 
brana   tympani,    in    which    case   blood    is   very   often   mixed   with  the 


238  TJie  Peninsular  and  Tndejwndent. 

secretion.  If  the  catarrhal  inflammation  extends  to  the  mucous  mem- 
brane of  the  membrana,  the  latter  becomes,  like  the  meatus,  thickened, 
and  often  very  much  congested.  The  membrane  then  loses  its  natural 
color  and  form;  if  we  are  able  to  employ  a  speculum,  the  outer 
surface  is  seen  to  be  flatter  than  usual ;  and,  in  consequence  of  its 
thickening,  neither  the  long  nor  the  short  process  of  the  stapes  is 
visible. 

In  the  treatment  of  catarrhal  otorrhoea,  it  is  of  the  first  impor- 
tance to  remove  the  secretion,  and  keep  the  meatus  clean.  This  is 
best  done  by  frequent  syringing  with  lukewarm  water.  If  there  be 
so  much  pain  or  tenderness  that  the  syringe  can  not  be  used,  one 
or  two  leeches  must  be  applied  to  the  outer  edge  of  the  meatus, 
followed  by  warm  fomentations  or  poultices,  or  the  vapor  of  warm 
water  may  by  directed  upon  the  ear.  After  all  tenderness  is  remo- 
ved, and  the  meatus  cleansed  from  the  secretion,  weak  astringent 
solutions  should  be  injected,  and  moderate  counter-irritation  applied 
to  the  mastoid  process.  These  simple  means,  in  connection  with  re- 
medies for  improving  the  general  health,  especially  tonics,  suffice,  in 
very  many  cases,  for  curing  the  discharge.  In  ver}'  obstinate  cases 
the  counter-irritation  to  the  mastoid  process  must  be  maintained,  so 
as  to  keep  up  an  artificial  discharge,  which  is  best  done  by  means 
of  croton  oil;  and  a  strong  solution  of  nitrate  of  silver  (ten  to  forty 
grains  to  the  ounce)  should  be  thrown  into  the  meatus  every  third 
day,   by   means  of  a   glass   syringe. 

There  are  cases,  however,  which  resist  this  treatment,  the  dis- 
charge continuing  unchanged  for  two  or  three  months.  The  treat- 
ment should  then  be  steadily  persevered  in,  as  it  may  at  least  pre- 
vent ulceration  of  the  membrane  of  the  tympanum,  caries  of  the 
bones,    and   the  development  of  polypi. 

[Translated  for  the  Boston  Med.  and  Surg.  Joiirna',  from  the  Juur.  fur  Kinderkrankheiten. 


ADHESIVE    PLASTER     IN  MAINTAINING    EXTENSION    AND   COUNTER - 
EXTENSION  IN  OBLIQUE   FRACTURES   OF    LOWER   EXTREMITEIS. 

From  the  illustrations  of  practice  in  the  Maj^  23d  No.  of  the 
Med.  S  Surg.  Ecimrter.,  we  learn  that  Desault's  splint,  as  modified 
by  Physick  and  HuTcniNSON,  is  still  preferred  by  the  surgeons  of  the 
Pennsylvania  Hospital  in  cases  of  fracture  of  the  thigh  bone ;  also, 
that  in  place  of  the  old  fashioned  gaiter,  etc.,  extension  is  effected 
as  follows : 

One  extremity  of  a  long  strip  of  adhesive  plaster,  two  inches 
wide,  is  attached  to  one  side  of  the  wounded  limb,  just  below  the  frac- 
ture; the  sti-ip  is  then  brought  down  to  the  foot,  care  being  taken  that 
the  plaster  is  firmly,  smoothly,  and  evenly  applied  to  the  limb;  in  its 
progress    downwards   the  loop   below    the  foot   is  made  by  the  strip  of 


Selected  Articles^  Abstracts^  dc.  239 

plaster  as  it  is  conducted  from  one  side  of  the  limb  to  be  similarly  applied 
to  the  other.  To  take  off  pressure  from  the  malleoli,  a  block  of  wood  of 
sufficient  size  is  placed  in  the  loop,  and  to  this  extending  bands  at- 
tached;  the  descending  and  ascending  strip  of  plaster  is  more  securely 
fastened  to  the  limb  by  a  few  strips  of  plaster  circularly  applied  to 
the  leg. 

Counter-extension  is  made  by  a  land  which  is  put  around  the  groin 
and  the  ends  fastened  to  the  top  of  the  splint. 

Dr.  Neill,  the  clinical  surgeon. 

Observed  that  the  great  secret  of  success  in  treating  fractures 
was  attending  to  the  skin ;  and  that  not  merely  the  proper  applica- 
tion of  dressings  was  necessary,  but  their  maintenance  in  proper  po- 
sition.    They  should  be   constantly   watched  and   re-applied. 

This  direction  may  by  complied  with  in  the  hospitals,  where 
skillful  attendants  are  always  at  hand,  but  in  private,  and  especially 
in  country,  practice,  a  method  of  steadily  maintaining  counter-exten- 
sion, simple  in  application,  comfortable  to  the  patient,  and  not  liable 
to   constant   derangement  is   still   regarded   as  a  desideratum. 

It  is  several  3^ears  since  Dr.  Gilbert  proposed  what  he  regarded 
as  such  a  method ;  and  we  notice  that  continued  experience,  support- 
ed by  that  of  other  respectable  practitioners,  has  strengthened  his 
original  views  of  its  superiority  over  all  other  modes  of  effecting 
counter-extension.  AYe  are  therefore  disappointed  at  finding  no  refer- 
ence to  his  plan   in  the  reports   of  hospital   practice. 

His  method  is  simply  to  substitute  for  the  ordinary  unadherent 
*'  band  around  the  groin"  —  which  is  always  liable  to  produce  more 
or  less  friction  and  ultimate  excoriation  —  a  strip  of  ahhesive  plaster 
similarly  applied,  attached  to  the  splint,  and  supported  by  one  or 
more   circular   strips   above   the   pelvis. 

Believing  that  Dr.  Gilbert's  process  is  not  generally  known,  we 
will   refer,   more  minutely,    to  his  interestin  g  paper   hereafter. 


BALSAM  COPAIBA  IN  PSORIASIS. 

At  the  Hospital  of  St.  Louis,  M.  Hardy  has  experimented  with 
Balsam  Copaiba  in  the  treatment  of  psoriasis.  Cases  not  materially 
beneSted  by  arsenic  and  the  ordinary  local  treatment,  jaelded  to  the 
internal  administration  of  the  balsam,  in  doses  gradually  increased  from 
three-fourths  of  a  drachm  to  two  drachms,  repeated  before  meals 
daily.  At  the  same  time,  the  usual  local  adjuvants  M-ere  applied 
with  advantage  in   cases   of  unusual   obstinacy.  y^'' 

TREATMENT  OF  HOOPING-OOUG  H  BY  DILUTED  NITRIC  ACID. 

Diluted  nitric  acid,  originally  recommended  in  pertussis  by  Dr. 
Arnold,   of   Montreal,    is    extolled   by    Dr.    Atceerly,   in   the   British 


240  The  Peninsular  and  Independent. 

Medical  Times  and  Gazette^  as  an  efficient  remedy  to  abbreviate  the 
ordinary  term  of  hooping-cough.  lie  prescribes  the  dihited  acid  in 
doses  of  five  minums  for  a  child  six  months  old,  every  third  hour, 
and  increases  the  doses  in  proportion  to  the  severity  of  tlie  symptoms 
to  fifteen  minums  every  second  hour.  The  dilute  acid  is  mixed  with 
compound  tinct.  of  cardamums,  syrup,  and  water,  which  renders  it 
quite   palatable.     In   conclusion  he  remarks : 

"In  conjunction  with  the  above  treatment,  I  have  invariably  employd 
a  stimulating  embrocation  to  the  back  and  chest,  night  and  morning, 
consisting  of  one  ounce  of  camphor  liniment,  and  two  drachms  of  spirits 
of  turpentine.  I  have  also  seen  great  benefit  from  the  inhalation  of  the 
fumes  of  burning  nitre-paper  :  two  pieces,  of  about  four  inches  square,  are 
burnt  in  the  bedroom,  on  retiring  to  rest,  and  one  piece  burnt  occasionally 
in  the  room  occupied  by  the  child  in  the  day  time,  appears  to  shorten 
the  paroxysm,  and  to  deprive  it,  in  a  great  measure,  of  its  spasmodic  cha- 
racter, rendering  it  more  like  the  cough  of  common  catarrh. 


THE  ORACLE  FAIRLY  COMMITTED. 

Skoda  —  the  greatest  of  non-commital  medical  skeptics  in  Europe  — 
has  ventured  to  express  a  decided  opinion,  as  appears  by  the  following 
translation : 

PhthiHis  —  STioda.  —  In  iXxaWiener  Medical  Zeit.  this  world-renowned 
practitioner  particulaily  refers  to  the  importance  of  vinous  and  malt  liquors 
in  consumption.  They  afibrd  one  of  the  most  eflicacious  means  of  arrest- 
ing the  diarrhoea  which  so  often  debilitates  the  patient,  give  a  tone  to  the 
digestive  organs,  and  furnish  an  agreeable  way  of  generally  stimulating 
the  system. 

In  chronic   tuberculosis,    with  or    without  accompanying  diarrhoea, 
Skoda  regards  wine  or  beer  as  more  valuable  than  quinia  or  opium. 

[Mei.  <5*  Surg.  Reporter  —  trans,  by  J.  A.  Demmk,  M.  D. 


MORPHIA  AND  CARBONATE  OF  SODA  FOR  RETENTION  OF  URINE. 

After  several  unsuccessful  eftbrts  to  pass  a  catheter  in  the  case  of  a 
patient  laboring  under  retention  of  urine,  and  the  failure  of  ordinary 
doses  of  laudanum,  enemas,  warm-baths,  etc.,  Mr.  \yHEEDEN  Cooke, 
surgeon  in  charge  of  the  Royal  Free  Hospital,  of  which  the  patient 
was   an  inmate,    ordered   the  following  prescription: 

One  grain  of  muriate  of  morphia,  with  a  drachm  of  sesquicarbonate, 
of  soda  every  two  hours.  In  the  course  of  the  night  the  patient  passed 
about  four  ounces  of  urine,  and  the  following  afternoon  the  bladder  was 
fully  relieved.  He  had  taken  seven  grains  of  morphia,  and  seven  drachms 
of  soda,  before  sufiicient  relief  could  be  obtained.     He  is  now  doing  well. 

[Lancet,  April  30, 1859. 


Selected  Articles^  Abstracts^  dbc.  241 

PERCHLORIDE  OF  IRON  IN  IN-GROWING  NAIL. 

After  fomentation,  Dr.  Alcantara  interposes  beneath  the  nail  a 
small  piece  of  lint,  upon  which  some  ointment  of  perchloride  of  iron 
has  been  spread.  All  the  surface  of  the  excrescence,  deprived  of  its 
epidermis,  is  covered  over  with  this,  and  the  dressing  renewed  twice 
a  day.  At  the  end  of  four  days,  the  excrescence  becomes  dry,  and 
is  easily  detached.  The  wound  then  assumes  a  healing  aspect,  and 
the   cure   is   completed  at   the  end  of  a   week. 

[  Union  Medicate. 
BISMUTH  SNUFF  IN  CORYZA. 

Mr.  MoNNEKET,  we  are  told  in  the  Recue  de  Therapeutique^  has 
established  the  services  of  subnitrate  of  bismuth  in  coryza ;  and  Dr. 
SoBHiER  lias  lately  shown  that  by  the  addition  of  iodide  of  sulphur 
to  it,  a  cure  for  chronic  coryza  is  obtained.  The  following  is  his 
formula: — Subnitrate  of  bismuth,  4  parts;  liquorice  powder,  8  parts; 
iodide  of  sulphur,  80  parts.  Of  this  compound  the  patient  is  to  take 
ten   or  twelve   pinches   in   the   day,  according   to  their   effect. 

[Med.    Tirites  and  Gaz.  April,  1859. 
SUPPRESSION  OF  ILLEGAL  PRACTICE  IN  PARIS. 

The  twelve  different  districts  of  the  French  capital  have  almost 
each  a  medical  society.  That  of  the  second  district  has  lately  decided 
that  all  the  societies  shall  be  requested  to  act  in  concert,  with  a  view 
to  suppressing  illegal  practice,  in  imitation  of  the  societies  of  Blois 
and  Lyons,  where  prosecutions  of  this  kind  have  been  highly  successful. 


THE  PHYSIOLOGY  AND  PATHOLOGY  OF  THE  THYMUS  GLAND. 

A  valuable  contribution  to  our  knowledge  u|)on  the  above  subject  has 
been  made  by  Dr.  Alex.  Friedleben. 

After  years  of  patient  and  toilsome  labor,  he  has  presented  to  the 
profession  a  most  concise  and  complete  essay  upon  this  obscure  subject. 

We  condense  the  following: 

Development  of  the  2'hymus. — At  the  very  beginning,  the  thymus 
appears  as  a  very  narrow  strip  of  blastema,  a  remnant  of  the  blastodermic 
membrane,  lying  along  the  carotid  vessels;  this  is  about  the  fifth  or  sixth 
week.  Between  the  sixth  and  eighth  week,  small  vesicles  bud  out  on 
every  side.  The  attachment  becoming  more  and  more  contracted,  until  a 
little  cellular  tissue  is  all  that  connects  each  vesicle  with  the  primitive 
strip,  now  membrane  —  this  cellular  tissue  serving  merely  as  a  connecting 
hand;  there  is  no  tubular  arrangement.  The  vesicles  increase  by  branch- 
ing into  twos  and  fours.  Every  vesicle  or  cell  is  a  distinct.,  independent 
unit. 

Vol.  II.  —  Q. 


242  The  Peninsular  and  Independent. 

From  the  time  of  the  first  appearance  in  the  embryo,  the  thymus  in- 
creases in  length.  This  increase  is  more  marked  after  birth  than  during 
embryonic  and  foetal  life.  After  the  twenty-fifth  year,  the  length  decreases 
until  the  gland  is  entirely  absorbed. 

The  absolute  weight  of  the  thymus  increases  until  the  end  of  the 
second  year,  then  remains  stationary  until  puberty ;  and  between  fifteen 
and  twenty-five  years  of  age  it  gradually  decreases,  and  after  twenty-five  a 
very  rapid  diminution  takes  place. 

The  specific  weight  is  greater  during  the  embryonic  state  —  decreases 
until  the  time  of  birth,  then  steadily  increases  until  the  end  of  the  second 
year,  after  which  it  again  diminishes. 

This  is  the  reverse  of  what  takes  place  in  the  liver  and  spleen. 

Secretion — Most  active  at  the  end  of  the  first  year  of  life ;  still  con- 
siderable during  the  second  year,  and  continues  lessening  from  day  to  day, 
until  puberty,  when  it  is  almost  suspended.  The  secretion  of  the  thymus 
consists  of  a  liquid,  crowded  with  granules,  and  presenting  all  the  appear- 
ances of  a  nutritive  fluid:  it  gives  an  acid  reaction.  This  fluid  he  has  also 
found  in  the  vena  thymica,  but  not  in  the  lymphatics. 

The  quantitive  analysis  of  the  gland  give  the  interesting  result  that 
after  the  embryonic  state,  the  earthly  phosphates  predominate,  until  the 
time  of  the  thymus  involution,  when  the  alkaline  phosphates  are  in  excess. 
This  is  particularly  interesting,  inasmuch  as  the  reverse  obtains  in  most 
of  the  other  organs. 

[From  the  German^  by  T.  A.  Bcmmc,  M.  D.     Translated  in  Medical  and  Surg.  Reporter. 


On  the  Physiological  Position  of  Fibrin. 


By    Levix    S.   Joynes,  M.  D., 
Professor   of  Institutes   of  Medicine  in  the  Medical   College  of  Virginia. 


The  mutability  of  medical  doctrines  has  become  a  by -word,  and, 
with  those  who  judge  harshly,  a  reproach.  An  old  French  medical 
writer,  Bordeu,  compared  the  human  mind  in  the  pursuit  of  scientific 
truth,  to  a  drunken  man  on  horseback,  who  inclines  first  to  one  side, 
and,  in  endeavoring  to  recover  himself,  is  sure  to  swing  as  far  over 
to  the  other;  so  that  he  finds  it  impossible  to  sit  straight  up  in  his 
saddle. 

In  no  department  of  our  science  has  the  multiplicity  of  opinions 
and  the  ceaseless  tendency  to  revolution  been  so  conspicuous  as  in  phy- 
siology. This  is  due  in  a  chief  degree  to  the  inherent  diflBculties 
and  obscurities  of  the  subject  it  embraces.  Where  facts  are  imperfectly 
understood,  they  may  admit  of  several  different  explanations,  one  or 
other    of  which    will    prevail    according    to    the  preconceived   ideas   of 


Selected  Articles^  Abstracts^  €&c.  243 

inquirers;  or,  an  accepted  doctrine  may  be  overturned  by  the  dis- 
covery of  new  facts,  which  are  found  to  be  irreconcilable  with  it. 
Besides  which,  the  surpassing  interest  which  invests  the  operations  of 
the  living  organism,  too  often  tempts  the  physiologist  to  the  exercise 
of  the  inventive  faculty  in  the  solution  of  the  problems  which  present 
themselves ;  and  thus  he  assumes  facts,  which  afterwards  turn  out  to 
be  false:  nor  can  it  be  denied  that  a  natural  instability  of  mind,  and 
an  innate  passion  for  novelty,  on  the  part  of  the  "interpreter  of 
nature,"  has  now  and  then  given  birth  to  a  new  theory.  We  can 
only  lament,  but  can  not  remedy,  the  changeful  aspect  of  the  science, 
until  the  arrival  of  the  long  distant  period,  when  we  shall  see  all 
things  clearly   in  the  full   light  of  positive  knowledge. 

A'^ong  the  many  unsettled  questions  which  are  at  this  time 
attracting  attention  and  inviting  discussion,  is  that  which  I  have 
chosen  as  the  subject  of  this  essay.  A  few  years  ago,  it  is  true,  no 
chapter  of  doctrine  seemed  better  established  than  that  which  relates 
to  the  physiological  relations  of  the  animal  principle  which  we  term 
Jibrin — its  origin,  uses,  and  destination  in  the  economy.  But  for  some 
time  past  there  have  been  indications  in  various  quarters,  of  a  grow- 
ing revolution  of  opinion  on  this  subject,  which,  in  a  theoretical 
aspect  at  least,  is  of  fundamental  importance  both  in  physiology  and 
pathology,  and  it  may  not  be  uninteresting  to  inquire  into  the  sufficiency 
of  the  grounds  on  which  it  is  sought  to  justify  the  change  of  faith. 

A  peculiar  interest  has  always  attached  to  the  substance  in  question, 
by  reason  of  the  remarkable  phenomena  in  which  it  takes  a  leading 
share.  The  coagulation  of  the  blood  is  entirely  due  to  its  agency.  Though 
held  in  perfect  solution  so  long  as  the  blood  is  flowing  in  the  living 
vessels,  no  sooner  is  this  fluid  withdrawn  from  the  body,  than  the  fibrin 
(in  the  exercise  of  a  property  which  is  inherent  in  it,  and  distinguishes 
it  from  all  other  animal  principles)  passes  spontaneously  to  the  solid 
state.  Its  particles  concrete  in  the  form  of  innumerable  delicate  fila- 
ments or  "  fibrils "  —  and  these,  by  crossing  and  interlacing  with  each 
other  in  a  thousand  different  directions,  form  a  close  net  -  work,  in  which 
the  red  and  white  corpuscles  are  entangled  and  held  fast:  and  thus  it 
is  that  the  fibrin  is  the  active  agent  in  the  coagulation  of  the  blood ;  and 
though  its  proportion  in  the  fluid  amounts  to  no  more  than  two  or  three 
parts  in  1,000,  it  holds  in  its  grasp  the  red  corpuscles,  whose  norma 
proportion  is  from  125  to  140  parts.  Next,  the  fibrinous  net -work  slowly 
contracts  and  presses  out  the  yellow  serum,  which  soon  surrounds  the 
clot  and  bathes  its  surface.  In  the  l)uffy  coat  of  inflammatory  blood, 
we   have  an  example  of  nearly   pure  fibrin. 

The  same  principle  is  also  an  ingredient  of  the  chyle  and  the 
lymph  —  the  proportion,  however,  being  less  than  in  the  blood;  but  it 
is  not  normally  found  in  any  of  the  secreted  fluids^  whether  those  of  the 


244  The  Peninsular  and  Independent. 

excrementitious  class,    or  those  destined    to   some   special   office    in    the 
economy. 

In  disease,  it  not  unfrequently  escapes  from  the  circulating  fluid, 
especially  in  acute  inflammations — being  a  constant  ingredient  of  that 
"coagulable  lymph"  which  is  so  often  poured  out  either  into  the  paren- 
chyma of  organs,  or  upon  their  membraneous  surfaces.  The  tendency 
to  such  exudations  is  accompanied  by  an  increased  proportion  of  fibrin 
in  the  blood,  which  is  as  invariable  an  attendant  of  inflammation  as  the 
vascular  engorgement  which  belongs  to  it. 

A  plastic  fluid  of  analogous  constitution  is  the  material  employed 
by  nature  in  the  reparation  of  injuries,  whether  wounds  of  soft  partb, 
or  fractures  of  bone;  and  in  both  kinds  of  exudation,  the  fibrin  mani- 
fests the  same  tendency  to  spontaneous  coagulation,  and  after  the  same 
manner,  as  in  the  blood. 

It  does  not  appear  that  fibrin  enters  into  the  composition  of  any  of 
the  living  tissues.  Formerly,  indeed,  it  was  universally  regarded  as  the 
chief  constituent  of  the  muscular  fibre ;  but  according  to  the  view  of 
the  leading  physiological  chemists  of  the  present  day,  the  substance  of 
muscle  consists  of  a  peculiar  principle  (named  syntonine  by  Ledmann, 
muscuUne  by  Robin  and  Vekdeil),  which  diff'ers  from  fibrin  in  some  well- 
marked  particulars,  corresponding  rather  with  albumen,  with  which  it  ij. 
said  to  be  quite  identical  in  composition. 

It  would  be  foreign  to  my  present  purpose  to  describe  in  detail  the 
physical  properties  and  chemical  characters  of  fibrin.  As  to  the  former, 
if  any  one  will  take  the  trouble  to  examine  the  huffy  coat  of  inflamma- 
tory blood,  or  to  stir  any  specimen  of  fresh  drawn  blood  with  a  sticky 
and  wash  the  clot  which  adheres  to  it,  to  remove  the  red  coloring  matter, 
he  will  obtain  a  better  idea  than  can  be  conveyed  by  any  verbal  de- 
scription; and  if  he  will  take  a  thin  film  of  the  white,  fibrous -looking 
elastic  substance  thus  obtained,  and  examine  it  carefully  with  a  good 
microscope,  he  will  readily  distinguish  the  filamentous  aiTangement  which 
fibrin  assumes  in  its  coagulation. 

In  chemical  characters,  its  close  relations  to  those  other  "protein 
compounds,"  albumen  and  casein,  are  admitted  by  all  chemists,  notwith- 
standing the  remarkable  differences  in  the  conditions  and  mode  of  their 
coagulation  —  neither  of  these  kindred  principles  exhibiting  any  tendency 
to  spontaneous  coagulation,  though  this  change  is  readily  induced  by 
chemical  agents.  In  neither  case,  however,  does  the  coagulum  present 
a  definite  arrangement  of  its  particles,  like  that  of  fibrin. 

As  it  respects  their  composition,  it  is  suflBcient  to  examine  the 
analyses  made  by  various  chemists  of  late  years,  to  be  satisfied  how 
near  is  their  resemblance.  It  appears  singular  indeed  that  two  ingredi- 
ents of  the  blood,  so  different  in  the  particular  just  referred  to  as  are 
albumen  and  fibrin,  should  be  so  nearly  identical  in  composition.     Socr^ 


Selected  Articles ^  Abstracts^  <&c.  245 

analyses,  it  is  true,  give  a  somewhat  larger  proportion  of  oxygen  for 
Sibrin;  and  great  importance  has  been  attached  to  this  dirTerence:  but, 
if  it  exist  at  all,  it  is  very  trifling.  In  the  comparative  analyses  given 
by  LiEBiG  in  his  Letters  on  Chemistry,  which  Robin  and  Verdeil  con- 
sider the  most  trustworthy,  no  such  excess  of  oxygen  appears,  but  the 
reverse — the  numbers  being,  for  albumen,  22*54  per  cent. ;  for  fibrin 
21-7. 

There  is  little  doubt  that  the  two  bodies  may  be  converted  into 
each  other  by  the  processes  of  vital  chemistry  —  fibrin,  when  taken  into 
the  stomach,  being  transformed  into  albumen  by  digestion,  and  so  ab- 
sorbed; and  albumen,  in  its  turn,  being  continually  transformed  into 
fibrin  in  the  chyle  and  blood.  There  is  every  reason,  indeed,  for  the 
belief  that  such  is  the  source  of  all  the  fibrin  which  the  blood  contains. 
This,  however,  is  rather  prejudging  a  point  in  controversy. 

The  views  heretofore  generally  current  in  reference  to  the  offices  of 
fibrin  in  the  economy,  assigned  to  it  the  highest  place  among  all  the 
proximate  principles.  It  was  regarded  as  an  organizible  compound — as 
the  organizable  principle  |?a7'  excellence  —  the  immediate  nourisher  of  the 
living  tissues  —  the  form  through  which  the  albumen  of  the  blood  (which 
so  largely  exceeds  it  in  amount)  must  pass  before  accomplishing  its  work 
of  nutrition.  It  is  to  this  end  that  fibrin  is  being  continually  elaborated 
out  of  the  kindred  compound,  in  the  blood,  the  chyle  and  the  lymph,  as 
they  flow  in  their  vessels.  Fibrin,  it  was  said,  is  not  a  mere  chemical 
compound^  like  albumen  or  gelatin,  but  already  half-vitalized^  and  en- 
dowed with  an  inherent  tendency  to  organization  —  this  being  manifested 
by  its  passing  spontaneonsly  to  the  solid  form,  by  the  regular  arrange- 
ment or  structure  which  its  particles  then  assume  (reminding  one  some- 
what of  an  organized  fibrous  tissue)  —  and  by  its  invariable  presence 
and  agency  in  those  plastic  exudations  which  become  organized  into 
false  membranes,  and  form  the  medium  of  the  healing  process.  Its 
supposed  presence  in  the  muscular  fibre,  as  the  basis  of  its  composition, 
was  also  appealed  to  as  a  fact  of  much  significance. 

Of  late  years,  however,  various  considerations  have  been  adduced, 
tending  to  invalidate  this  attractive  theory,  and  to  establish  in  its  place 
one  which  is  more  or  less  completely  the  reverse  of  it.  Among  the  par- 
tisans of  this  new  view,  may  be  mentioned  the  names  of  Zimmerman, 
John  Simon,  Handfield  Jones,  Brown -Sequard,  Bernard,  and  Rokitan- 
SKY,  whose  authority  in  the  world  of  science  certainly  entitles  it  to  a 
candid  and  deliberate  examination. 

Fibrin,  it  is  maintained,  so  far  from  being  a  peculiarly  organizable 
or  plastic  material,  and  the  immediate  pabulum  of  the  most  highly- vital- 
ized tissues,  is,  in  reality,  an  excrementitious  compound^  not  at  all  avail- 
able for  nutrition,  and  to  be  reckoned  "among  those  elements  which  have 
■arisen  in  the  blood  from  its  own  decay,  or  have  reverted  to  it  from  the 


246  The  Peninsular  and  Independent. 

waste  of  the  tissues,"  and  are  in  process  of  elimination  from  the  system. 
{Simon^s  General  Pathology^  p.  44.)  Rokitansky  speaks  of  it  as  "  an 
excretory  formation  —  a  substance  brought  by  oxidation  nigh  to  the 
state  of  disintegration — an  albuminous  matter  consumed  by  oxidation,'^ 
&c.,  &c. 

All  idea  of  vitality  as  appertaining  to  fibrin,  is  of  course  repudiated, 
and  its  coagulation  is  regarded  as  a  mere  physical  consolidation,  or  a  pre- 
cipitation from  solution,  induced  by  external  conditions,  and  no  more 
vital  than  the  coagulation  which  we  cause  in  an  egg  by  boiling  it,  or  in 
milk  by  the  addition  of  an  acid. 

Fibrin  being  deposed  from  its  high  oflBce,  it  is  of  course  albumen 
that  takes  its  place  as  the  great  plastic  and  tissue -forming  element  of 
the  blood. 

Some,  however,  modify  this  view  so  far  as  to  admit  that  fibrin  is  ca- 
pable of  a  certain  degree  of  organization,  but  of  a  very  low  kind,  never 
rising  above  the  grade  of  the  white  fibrous  or  the  areolar  tissue.  It  is 
completely  foreign  to  the  nutrition  of  the  higher  tissues,  such  as  the 
muscular  and  the  nervous. 

[To  be  concluded  in  (he  August  No.] 


lErmat^tttital  Jeprtment. 


Fluid  Extract  of  Yarrow. 

A  new  therapeutical  use  for  Yarrow  (Achillea  millefolia)  having 
been  noted  in  our  last  No.,  we  here  insert  a  formula  for  a  fluid 
extract,  which  we  take  from  the  Journal  of  Maryland  College  of 
Pharmacy : 

Take  of  Yarrow  (the  recently  dried  herb)  in  coarse  powder  eight 
ounces  (officinal),  alcohol  diluted  (two  parts  95  per  cent,  alcohol  and  one 
part  water)  a  sufficient  quantity.  Pour  over  the  powdered  herb  four 
ounces  of  the  diluted  alcohol,  and  work  through  with  the  hands  until 
thoroughly  moistened ;  allow  it  to  stand  in  a  covered  jar  for  24  hours. 
Pack  closely  in  a  funnel  or  other  displacer,  and  proceed  to  displace,  until 
twenty-four  fluid  ounces  are  obtained,  which,  if  performed  with  proper 
care,  will  exhaust  the  herb,  as  tested  by  tasting  the  droppings.  The 
resulting  liquid  should  be  exposed  in  a  shallow  dish  (in  summer  to  a  draft 
of  air  under  an  open  window,  in  winter  on  a  shelf  near  the  top  of  the 
room),  and  allowed  to  evaporate  spontaneously  until  it  measures  sixteen 
fluid  ounces.  Thirty  or  forty  grains  bi-carb.  potassa  in  powder  may  then 
be  added,  which  retains  the  extractive  in  solution  and  clears  the  liquid, 
without  interfering  with  its  properties. 

The  evaporation  of  this  fluid  extract  may  be  continued,  if  desired, 
with  a  very  gentle  heat  (in  a  water-bath),  until  reduced  to  the  consistence 
of  an  ordinary  extract.  The  result  in  either  case,  fluid  or  solid,  possesses 
in  a  marked  degree  the  sensible  and  other  properties  of  the  herb,  each 
teaspoonful  representing  30  grains  of  the  herb. 

As  Yarrow  possesses  tonic,  astringent,  and  expectorant  powers,  in 
addition  to  those  noted  in  our  last,  it  is  probable  that  its  use  will  be- 
come more   extended  as   its   merits   are   known. 


Goulard's  Cerate  substituted  by  a  Glycerole  of  Lead. 

Draylit  (Why  not  Daylight?)  proposes  (Journal  of  Maryland 
College  of  Pharmacy)  the  following  glycerole  as  a  substitute  for 
Goulard's   Cerate.     He  says : 

This  cerate,  as  is  well  known,  becomes  speedily  rancid,  and  in  that 
state   is   more  irritating  than   soothing  to  inflamed  surfaces.     The  sub- 


248  The  Peninsular  and  Independent. 

stitute  does  not  change,  is  easily  washed  oflf  with  water,  and  can  be 
reduced  to  any  desired  extent,  for  the  purposes  of  a  wash,  with  rose  or 
distilled  water. 

Take  of  Pure  Glycerin 13ioz.  (fluid). 

Solution  of  Sub-acetate  of  Lead          .          .      2^oz.        " 
Camphor \  drachm. 

Triturate  the  camphor  into  powder  with  a  few  drops  of  alcohol ;  add 
the  glycerin;  heat  in  a  water  bath  until  the  camphor  is  dissolved;  when 
cool,  add  the  solution  of  lead,  and  shake  well  together. 

These  proportions  are  those  for  Goulard's  Cerate,  feubstituting  glycerin 
for  the  oil  and  wax. 


The  PreserTation  of  Infusious. 

Mr.  Robertson,  a  pharmaceutist  of  London,  recommends  that  in- 
fusions be  preserved  by  filling  bottles  of  any  convenient  size  (with  them 
when  freshly  prepared  and  filtered)  up  to  the  bottom  of  the  neck.  These 
are  placed  in  a  vessel  of  water,  put  on  the  fire,  and  allowed  to  remain 
until  the  water  has  boiled  around  them  for  ten  or  fifteen  minutes ;  by 
this  time  the  infusions  will  be  found  running  over  the  brims  of  the 
bottles.  They  are  then  removed  one  by  one,  and  immediately  closed  by 
simply  tying  a  piece  of  moistened  bladder  over  the  top. 

Infusions  can  be  prepared  for  a  three  or  six  months'  supply,  without 
danger  of  loss. 

Althea  Paper,  a  New  Test  for  Acids  and  Alkalies. 

Prof.  AiKiN  {Jour.  Maryland  College  Pharmacy)  proposes  the  color- 
ing matter  of  the  flowers  of  Althea  Rosea  (Hollyhock)  as  a  substitute  for 
litmus  and  turmeric,  as  a  test.  These  flowers  are  largely  imported  for  the 
purpose  of  coloring  artificial  wines,  &c.  He  states  that  the  paper  prepared 
with  the  coloring  matter  of  Hollyhock  is  more  permanent,  and  fully  equal 
in  sensitiveness  to  limus  paper. 

Samaderine. 

This  substance  has  recently  been  isolated  (as  a  new  organic  body) 
from  the  fruit  of  a  tree  found  in  Java,  of  the  order  Simaruboe,  {Samadera 
indica).  It  is  crystalline,  indifferent  to  most  reagents,  and  may  be  classed 
with  salicine,  phloridzine,  &c.,  and  possesses  a  most  intense  and  per- 
sistent bitter  taste.  As  the  bark  of  the  many  trees  of  the  order  Simarubm 
are  esteemed  as  tonics,  it  may  be  that  in  Samadarine  there  has  been  a 
valuable  addition   to  Materia  Medica. 


Pharmaceutical  Bepartment  249 

EMPLOYMENT  OF  IODIDE  OF  SODIUM.    Bt  Alexander  Ure,  Esq.,  F.  R.  C.  S- 

I  submit  to  the  profession  the  following  observations  respecting 
medicines,  which  will,  I  trust  be  found  useful  in  practice.  Iodide  of 
sodium  is  met  with  in  the  ashes  of  sea-weed  and  of  various  plants 
which  grow  on  the  sea-shore.  To  this  source  may  be  reasonably 
ascribed  the  belief  entertained  in  the  healing  virtues  of  sea-weed  by 
inhabitants  of  the  coast  in  different  parts  of  the  globe.  Professor 
Laycock,  in  an  ingenious  address  which  he  delivered  at  the  pharma- 
ceutical meeting  in  Edinburgh  last  November,  and  which  is  published 
in  the  PharmaceiLtical  Journal  of  the  month  following,  states  that 
*'in  the  pampas  of  South  America,  where  goitre  is  prevalent,  the 
remedy,  a  so-called  goitre-stick,  is  nothing  more  than  the  thick  stem 
of  a  sea-weed."  Mr.  Cooper,  in  his  "Surgical  Dictionary,"  recommends 
for  some   scrofulous   affections  the   use   of  poultices   of  sea-weed. 

Iodide  of  sodium,  as  a  therapeutic  agent,  is,  and  ought  to  be, 
more  active  than  iodide  of  potassium,  since  it  is  richer  in  iodine. 
According  to  Gmelin,  iodide  of  sodium  contains  84*45  parts  of  iodine 
in  the  hundred,  while  iodide  of  potassium  contains  but  74*27,  the 
proportion  of  sodium,  though  small,  being  still  sufficient  to  cover  the 
irritative   quality   of  its   associate. 

As  far  as  my  experience  goes,  iodide  of  sodium  is  a  blander 
salt,  more  assimilable,  and  better  borne  by  the  stomach,  than  iodide 
of  potassium.  It  is  moreover,  much  less  prone  to  produce  symptoms 
of  iodic  disturbance.  Patients  under  my  care  have  taken  it  steadily 
for  weeks  together,  without  suffering  the  slightest  inconvenience,  and 
with  uniform  advantage  as  regarded  the  morbid  condition.  On  no 
occasion,  save  one,  has  there  been  any  complaint  made  of  this  me- 
dicine producing  sense  of  w'eight  or  uneasiness  referred  to  the  stomach, 
nausea,  impaired  appetite  and  digestion,  headache,  running  from  the 
eyes  and  nostrils,  general  nervous  depression  —  symptoms  which  at 
times  supervene  during  the  administration  of  iodide  of  potassium, 
even  in  moderate  doses.  The  instance  in  question  was  that  of  a 
puny,   scrofulous  boy   with  disease   in  both   knee-joints. 

As  a  general  rule,  the  preparations  of  soda  are  milder  in  their 
operation  on  the  system  than  those  of  potash.  If,  moreover,  the 
important  view,  first  announced  by  M.  Dumas  in  the  92d  volume 
of  the  "Annales  de  Chimie,"  be  accepted,  that  there  are  certain 
salts  which  leave  the  blood  the  faculty  of  becoming  arterialized, 
while  others  deprive  it  of  this  property,  and  that  the  salts  having 
soda  for  their  base  are  more  proper  to  maintain  this  condition  of 
integrity  that  those  of  potash  or  ammonia,  it  may  be  fairly  assumed 
that  the  former  are  likely  to  exercise  a  more  favorable  remedial  in- 
fluence than  the  latter,  especially  if  exhibited  continuously  for  a 
length    of    time.      Soda,    variously    combined,    is    diffused    extensively 


250  The  Peninsular  and  Independent. 

throughout  the  organism ;  fully  five-sixths  of  the  saline  constituents 
of  healthy  blood  consists   of  salts   of  this  base. 

Iodide  of  sodium  may  be  prescribed  in  all  cases  in  which  the 
employment  of  iodide  of  potassium  is  indicated,  as  antidotal  to  various 
constitutional  symptoms  of  syphilis,  chiefly  of  the  so-called  tertiary 
group,  and  where  mercury  has  been  properly  used  beforehand ;  in 
certain  forms  of  rheumatism ;  in  chronic  affections  of  the  joints  and 
bones  of  a  scrofulous  character,  particularly  where  a  stealthy  inflam- 
matory process  has  determined  copious  fibro-plastic  deposition  or  hyper- 
trophy. If  judiciously  administered,  it  may  given  in  progessively- 
increasing  doses,  where  it  is  desirable  to  produce  a  decided  alterative 
efi'ect  on  the  system.  M.  Gamberini  has  famished  a  brief  notice  res- 
pecting its  use  in  the  volume  Schmidt's  "Jahrbiicher"  for  1858. 
Reference  is  made  to  116  cases  of  constitutional  syphilis  in  which  it 
had  been  exhibited,  and  where  it  was  found  to  have  acted  more 
rapidly  than  iodide  of  potassium,  and  often  proved  efficacious  where 
the  latter  drug  had  been  of  little  or  no  avail.  It  is  there  recom- 
mended to  be  given  as  follows :  —  One  scruple  is  to  be  dissolved  in 
three  ounces  of  distilled  water,  and  this  is  to  be  swallowed  in  di- 
vided doses  in  the  course  of  the  day.  After  the  lapse  of  two  or  three 
day,  the  above  amount  is  to  be  augmented  by  the  addition  of  six 
grains;  and  so  on  until  eventually  the  patient  comes  to  take  two 
drachms,  or  even  more,  of  the  salt  daily ;  the  time  for  taking  each 
dose  being  an   hour  before    meals. 

Hitherto  I  have  usually  prescribed  the  iodide  of  sodium  to  the 
extent  of  five  or  six  grains  twice  or  thrice  daily,  dissolved  in  four 
ounces  of  compound  decoction  of  sarsaparilla,  which  forms  a  convenient 
vehicle ;  occasionally,  in  pure  water,  with  the  addition  of  five  grains 
of  bicarbonate  of  soda  to  each  dose;  this  serves  to  counteract  aces- 
cency,  and  the  consequent  liberation  of  hydriodic  acid  in  the  stomach, 
which  is  sure  to  cause  headache.  In  scrofulous  complaints,  I  have 
given  it,  combined  with  cod-liver  oil,  and  with  manifest  benefit.  A 
remarkable  and  unexpected  effect  was  observed  in  one  instance  under 
this  treatment  for  diseased  bone,  where  a  marked  improvement  of 
sight  ensued  from  diminution  of  a  nebulous  condition  of  the  cornea. 
In  constitutional  syphilis,  I  have  found  it  advantageous  occasionally 
to  conjoin  the  use  of  the  iodide  with  that  of  bichloride  of  mercury, 
should  mercury  have  been  previously  withheld,  or  imperfectly  intro- 
duced into   the   patient's   system. 

As  a  general  rule,  the  iodide  ought  to  be  administered  in  plenty 
of  liquid,  and  not  on  an  empty  stomach,  as  suggCoCed  by  the  above  writer. 
It  is  readily  soluble  in  water,  has  a  cooling  saline  taste,  certainly  prefer- 
able to  that  of  potassium  compound,  and  by  no  means  equally  persistent 
in  the  throat. 


Pharmaceutical  Department.  251 

Subjoined  are  the  notes  of  one  of  the  several  cases  in  which  this 
medicine  has  been  employed  by  me.  Reports  of  others,  still  under 
treatment,  will  be  duly  communicated : 

G.  W ,    aged  twenty-eight,    a  footman,    was  admitted  into  St. 

Mary's  Hospital,  under  my  care,  on  the  15th  of  November,  1856.  He 
was  a  wan,  emaciated,  cachectic -looking  man.  He  complained  of  pain, 
referred  to  the  large  joints,  and  of  aching  in  the  back  and  loins.  He 
was  disfigured  by  patches  of  rupia,  scattered  over  different  parts  of  the 
surface ;  thus,  on  the  right  side  of  the  nose,  at  the  junction  of  the  nasal 
bone  with  the  cartilage,  was  a  dark  oval  scab,  overlying  a  sore  the  size  of 
a  shilling,  and  which  seemed,  as  it  were,  eating  its  way  into  the  nostril ;  on 
the  tragus  of  the  right  ear  was  a  similar  scab,  as  also  over  the  right  eye- 
brow ;  on  the  scalp  there  were  several  scabs  of  the  same  character ;  on  the 
right  arm  was  a  prominent  hardened  scab,  and  another  over  the  left 
wrist;  behind  the  inner  ancle  of  the  left  foot  was  a  round  excavated 
sore,  of  a  dusky -red  hue,  the  sequel  of  inflammation  of  the  corial  tissue. 
Each  scab  had  been  preceded  by  the  formation  of  a  small  vesicle  of  a 
punctuate  character.  This  eruption  was  of  a  month's  standing.  He 
suffered  besides  from  an  affection  of  the  throat  of  three  weeks'  duration, 
which  caused  great  distress  in  swallowing.  On  examination,  it  was  as- 
certained that  there  was  a  deep  oval  ulcer  in  the  the  left  tonsil,  covered 
with  a  grayish -yellow  film,  and  a  similar  sore  in  the  mucous  membrane 
of  the  back  of  the  pharynx.  He  had  enjoyed  good  health  until  fiive 
weeks  preceding  his  admission,  when  he  had  an  attack  of  rheumatism, 
and  for  which  he  was  successfully  treated  in  this  hospital.  He  denied 
ever  having  had  any  venereal  malady ;  had  then  been  married  fourteen 
months,  and  was  the  father  of  a  healthy  child. 

No'\).  V^ih. — After  the  scabs  had  been  softened  and  partially  detached 
by  the  application  of  wet  lint,  I  directed  the  different  spots  to  be  touched 
with  nitric  acid ;  the  sores  in  the  throat  to  be  swabbed  daily  with  dilute 
hydrochloric  acid ;  and  the  patient  to  take  five  grains  of  iodide  of  sodium 
in  four  ounces  of  compound  decoction  of  sarsaparilla,  thrice  every  day. 
Ordinary  diet. 

^hih. — Was  improved  in  all  respects,  more  particularly  as  regarded 
appetite. 

29  «^. — General  amendment ;  sores  in  the  throat  were  much  reduced 
in  size. 

Dec,  %d. — Nitric  acid  was  applied  to  the  crusts  on  the  scalp. 

^th. — The  ulcer  of  the  tonsil  was  healed,  and  that  at  the  back  of 
the  pharynx  nearly  so. 

^tli. — The  sore  on  the  nose  was  making  favorable  progress  under 
the  use  of  water  -  dressing ;  the  rupia  scabs  were  all  disappearing,  and 
there  was  manifest  improvement  of  the  general  health.  The  patient  was 
ordered  to  have  a  warm  bath  twice  a  week. 


252  The  Peninsular  and  Independent. 

15th. — The  throat  was  quite  well;  the  sore  on  the  nose  and  that  near 
the  ancle,  were  completely  cicatrized ;  the  rupia  was  extinct.  The  patient 
had  evidently  gained  in  flesh  and  strength;  his  cheeks  were  plump,  his 
complexion  was  florid,  and  he  was  perfectl}?-  free  from  pain  in  the  back, 
loins,  or  joints.  He  vras  discharged  cured  on  the  24th  of  December,  1858, 
a,fter  a  sojourn  of  thirty-nine  days  in  the  hospital. 

Nothing  could  be  more  satisfactory  than  the  result  of  treatment  in 
this  instance,  which  was  simpl}^  that  of  uninterrupted  progress  to  re- 
covery. The  case  was  one  of  the  eroding  variety  of  rupia,  termed  by 
some  writers  rupia  escharotica,  and  which  is  occasionally  witnessed  in 
the  persons  of  those  who  have  been  affected  with  the  constitutional 
symptoms  of  syphilis.  The  man,  at  the  time  of  his  admission,  was  in 
a  deplorable  state  of  health;  his  throat  was  the  seat  of  foul  ulcers,  one 
side  of  his  nose  was  on  the  verge  of  mutilation,  his  body  was  racked  with 
pain,  his  countenance  marred  by  an  unsightly  eruption.  After  the  lapse 
of  about  five  weeks,  he  had  regained  his  wonted  health,  and  returned 
home  without  any  appreciable  trace  of  the  disfiguring  malady  for  which 
he  had  sought  relief  within  the  walls  of  an  hospital. 

[London  Lancet. 

A  SUBSTITUTE  FOR  COD  LIVER  OIL. 

The  oil  of  the  dugong  has  been  lately  proposed  as  a  substitute  for 
cod -liver  oil  by  Australian  physicians.  Dr.  Hobbs,  Medical  Health  OflBcer 
of  Moreton  Bay,  Australia,  has  again  called  attention  to  its  curative  pro- 
perties ;  and  if  this  oil  should  prove  as  efficacious  in  the  hands  of  others 
as  he  believes  it  has  been  in  his  own,  there  will  be  great  reason  for 
congratulation.  The  dugong  is  very  abundant  in  the  Australian  waters 
and  in  the  Indian  seas,  and  might  be  obtained  in  large  quantities  at  a 
moderate  cost.  It  has  the  advantage  of  being  a  pure,  sweet,  and  palatable 
oil,  which  may  be  used  in  cooking,  and  is  peculiarly  digestible.  On  the 
other  hand  it  does  not  contain  iodine.  Those  who  look  upon  the  iodine 
of  cod -liver  oil  as  an  active  and  important  agent  in  the  production  of  its 
peculiar  effects,  will  probably  be  disinclined  to  accept  this  report  in  all 
its  details ;  it  strengthens  the  hands  of  those  physicians  who  believe  that 
cod -liver  oil  is  mainly  valuable  as  supplying,  in  a  digestible  form,  car- 
bonaceous material,  and  thus  sustaining  enfeebled  vitality.  Dr.  Hobbs 
prescribes  dugong  oil  in  those  cases  in  which  cod -liver  oil  is  usually  pre- 
scribed, and  his  success  has  been  very  encouraging.  He  believes  that  it 
is  particularly  well  suited  to  the  form  of  disease  known  as  "dyspeptic 
phthisis."  The  statements  of  Dr.  Hobbs  are  well  worthy  the  attention  of 
the  Profession  ;  and  if  it  be  found  that  the  dugong  oil  can  be  substituted 
advantageously  for  cod -liver  oil,  the  gain  will  be  great  to  the  patient, 
who  will  thus  be  enabled  to  procure  an  agreeable  and  palatable  oil  at  a 
much  less  cost  than  that  of  the  more  nauseous  and  unpleasant  medica- 
ment, now  in  such  high  esteem.  [London  Luncet. 


Pharmaceutical  Department.  253 

THE  ACID  NITRATE  OF  SILVER. 

M.  Crocq  lately  read  a  paper  before  the  Medical  Society  of  Brussels, 
wherein  he  sets  forth  the  advantages  of  a  caustic  solution  hitherto  not 
much  employed — namely,  the  acid  nitrate  of  silver.  The  author  states 
that  it  should  be  used  when  the  surface  acted  upon  is  to  be  more  or  less 
deeply  modified,  without  an  intention  of  destroying  much  thickness  of 
tissue  —  in  fact,  in  those  cases  where  the  solid  nitrate  of  silver  or  the 
acid  nitrate  of  mercury  are  generally  used.  The  acid  nitrate  of  silver 
is,  however,  superior  to  the  simple  nitrate,  as  it  penetrates  much  better 
into  interstices,  and  as  its  action  may  at  will  be  made  superficial  or  deep 
(the  difference  depending  on  the  longer  or  shorter  contact).  It  is  also 
preferable  to  the  acid  nitrate  of  mercury  because  it  produces  no  tonic 
effects,  and  never  gives  rise  to  alarming  symptoms,  however  extensive  the 
surface  may  be  with  which  it  is  brought  in  contact.  Nor  can  it  excite 
salivation.  Its  action  can,  moreover,  be  at  once  stopped  when  the  vagina, 
the  mouth,  or  the  eye  are  operated  upon,  as  an  injection  of  a  solution  of 
common  salt  will  immediately  render  it  inert.  Chancres,  simple  or  slough- 
ing ulcers,  hospital  gangrene,  lupus,  epithelial  cancer,  &c.,  can  be  treated 
with  this  caustic  solution.  It  may  be  prepared  either  from  the  simple 
nitrate  or  from  metallic  silver.  To  obtain  it  from  the  lunar  salt  it  will 
be  sufiicient  to  add  eight  times  by  weight  of  nitric  acid,  at  33  deg.,  to 
the  nitrate  of  silver,  and  expose  to  heat  in  a  stopped  bottle.  With  me- 
tallic silver,  ten  times  the  weight  of  nitric  acid,  at  35  deg.,  should  be 
poured  on  the  metal,  and  a  gentle  heat  be  used. 

\ France  Medicale  —  from  Lancet. 


kOUSSINE. 

M.  Pavesi,  and  subsequently  M.  Vee,  have  succeeded  in  extracting 
the  active  principles  of  kousso.  The  following  is  the  process:  — 300 
grammes  of  kousso  are  treated  with  100  grammes  of  alcohol,  and  25 
grammes  of  hydrate  of  lime,  at  a  temperature  of  from  140"  to  \bO° 
Fahr.;  the  residue  is  also  digested  in  600  grammes  of  barley-water.  The 
solutions  thus  obtained  are  mixed  together,  filtered,  and  precipitated  by 
acetic  acid. 

Koussine  is  yellow,  bitter,  insoluble  in  alcohol  and  in  alkalies,  and 
does  not  crystallize. 

^PURIFICATION  OF  SPIRIT  FROM  FUSEL  OIL. 

M.  Bketon  {Moniteur  Industriel)  has  proposed  a  method  of 
purifying  spirit  in  the  small  way ;  consisting  in  taking  advantage  of  the 
solubility  of  Fusel  Oil  in  Olive  Oil,  which,  however  can  not  dissolve 
the  spirit.    He  states  he 

First  made  use  of  a  filter  consisting  of  disks  of  woolen  stuff,  slightly 
soaked  in  oil,  and  held  between  two  perforated  plates  of  metal.  The 
spirit   was    deprived  of  fusel    oil,    but   only  until  the  woolen  cloth  was 


254  The  Peninsular  and  Independent. 

saturated  with  the  volatile  oil,  when  it  absorbed  no  more.  By  means 
of  a  current  of  steam  at  pressure  of  two  or  three  atmospheres,  the  wool 
could  be  readily  freed  from  the  volatile  oil ;  but  the  exposure  to  steam 
at  this  temperature  rendered  the  wool  useless  for  a  repetition  of  the 
process.  The  woolen  stuff  consequently  had  to  be  given  up,  and  after 
many  trials  it  was  replaced  by  a  layer  of  powdered  pumice-stone,  which 
acts  exactly  in  the  same  way  as  the  woolen  stuff,  but  without  losing 
its  power  of  absorption  when  exposed  to  a  temperature  necessary  for 
the  volatilization  of  the  fusel  oil. 


IODIZED  FOOD. 

Dr.  BioNET,  of  the  French  Academy  of  Medicine,  in  a  recent  paper 
asserts  that  scrofula  and  other  cachexiae,  may  be  removed  by  introdu- 
cing iodine  into  the  general  diet  of  the  patient.  He  proposes  to  do  this 
by  making  iodized  food,  compounded  of  such  plants  as  contain  iodine, 
as  sea  weeds  and  cruciferous  plants,  and  introduced  into  bread,  cakes, 
syrups,  etc. 

THE  "SPANISH  APPLE." 

Dr.  T.  MoKTON  Lyle,  of  Gonzales,  Texas  (lY.  0.  Med.  New8\  re- 
commends the  Spanish  apple  —  Mahamscus  Drummondii  —  as  a  valu- 
able addition  to  our  catalogue  of  demulcents  and  emollients.  Dr. 
Lyle  uses  the  root,  though  the  whole  plant  abounds  with  the  mu- 
cilaginous principle.  He  regards  the  mucilage  as  superior  to  that  of 
the  Cactus  Opuntia  or  the  Ulmus  Fulva.  He  employs  it  internally  in 
cases  in  which  demulcents  are  indicated,  and  externally  in  the  form 
of  cataplasms,  ointments,  etc.  Why  might  there  not  be  an  officinal 
ointment  prepared  from  it — Ung.  Malvavlsci  —  to  occupy  the  place  of 
the  Wng.  Althem  of  the  British  pharmacopoeias,  which  is  certainly  a 
useful  preparation.  [Med.  and  Surg.  Eep. 


CHLORIDE  OF  SODIUM  IN  CHRONIC  ULCERATION  OF  THE  CORNEA. 

M.  Tavignot  states  that  since  he  first  recommended  this  substance 
in  1843  he  has  met  with  numbers  of  cases,  all  exhibiting  its  remarkable 
efScacy.  His  formula  is  15  parts  of  the  chloride  to  125  of  filtered 
water.  [Moniteur  des  Hop.  1858,  No.  152.^ 

REVULSIVE  TREATMENT  OF  CHRONIC  AFFECTIONS  OF  THE  EYE. 

This,  when  properly  applied,  M.  Tavignot  regards  as  a  valuable 
adjuvant.  He  employs  two  kinds  simultaneously — 1.  A  cutaneous  ve- 
vulsive,  of  which  the  following  is  the  formula:  Resin,  yellow  wax,  of 
each  100;  turpentine,  50;  powdered  euphorbium,  25;  powdered  can- 
tharides,  15 ;   and  croton  oil,  5   parts.      This  is  less  painful  than  anti- 


Pharmaceutical  Department.  256 

monial  revulsives,  and  may  be  kept  applied  to  the  nape  if  both  eyes 
are  effected,  and  behind  the  ear  if  only  one,  for  two  or  three  weeks, 
without  inducing  excessive  irritation.  2.  The  mucous  revulsive  is  formed 
of —  powdered  iris,  25  ;  calomel,  4 ;  and  camphor,  2  parts.  This  is  used 
as  snuff  five  or  six  times  a  day,  after  blowing  the  nose.  It  excites 
the  pituitary  membrane  very  advantageously,  in  nervous  affections  of 
the  eyes.  [Moniteur  des  Hop.  1858,  No.  152. 


NEWS   ITEMS. 


The  New  British  Pharmacopoeia  is  being  prepared  by  the  Medical 
Council.  At  present  there  exists  three  works  of  the  kind,  under  direc- 
tions respectively  to  the  Colleges  of  Physicians  of  London,  Edinburgh, 
and  Dublin,  producing  a  confusing  diversity  in  pharmaceutical  practice. 
The  object  is  now  to  reconcile  these  inconvenient  discrepancies,  and 
produce  a  uniform  national  pharmacopoeia. 

Much   temporary   annoyance,    it   is   believed,    will   be   produced   by         "'Y"" 
the   change,  but  the  result  will  be  satisfactory,  and  will   create  a  uni-  ^ 

formity  which  has  been  much  needed. 

It  has  been  decided  to  adopt  the  Avoirdupois  weight  instead  of 
the  Troy  weight,  or  Apothecaries'  weight,  and  the  work  will  be  pub- 
lished  in   the  English  language  instead  of  the  Latin.  ^ 

Some  of  the  standard  medical  authorities  have  recently  been  trans-  "\^ 
lated  into  the  Chinese  language  by  Dr.  Hobson.  They  include  works  \ 
on  the  following  subjects  :  Philosophy  and  General  Anatomy,  Surgery, 
Diseases  of  Women  and  Children,  Medicine  and  Materia  Medica,  and 
on  General  Science.  Some  of  these  works  have  created  great  interest 
in  them,  and  have  been  re-published  by  Chinese  Mandarins,  and  widely 
circulated  over  China  and  Japan.  The  medical  works  of  the  Chinese 
show  them  to  be  totally  ignorant  of  medicine  as  a  science.  Anatomy 
has  never   been   studied,  and   they   do   not   comprehend   the   circulation  . 

nor    the  functions   of  the   viscerse.      It  is   believed  that  this   series   of       V**^ 
treatises  will  spread  much  useful   information  among  their  practitioners, 
and  induce  attention  to  medical  science. 

A  company  of  Virginians  are  now  erecting  warehouses  at  various  points  "^\ 

in  the  big  woods,  near  Minneapolis,  Minnesota,  fitted  up  with  the  necessary 
apparatus  for  curing  ginseng.     They  intend  to  go  into  the  business  on  an  ex- 
tensive plan.     From  60,000  to  60,000  pounds  will  be  gathered  this  year,  which 
will  net  the  diggers  some  sixteen  thousand  dollars.     We  export  ginseng  _^^ 
to  China. 

In  St.  Louis,  stereoscopic  pictures  have  recently  been  taken  of  different       '"""^ 
dissections  of  the  muscles,  by  Mr.  J.  P.  Soule.     He  has  already  prepared  a 
number  of  these,  and  proposes  to  continue  the  series  and  prepare  views 
of  the  arteries,  &c.     The  pictures  are  very  beautiful,  and  should  the  artist 
succeed  in  coloring  them  satisfactorily,  their  value  will  be  greatly  enhanced. 

The  Emperor  Napoleon  has  decreed  a  statue  of  Humboldt  to  be  placsd 
in  the  gallery  at  Versailles. 


,-^ 


256  The  Peninsular  and  Independent. 

In  Paris,  England,  and  Genoa,  the  number  of  deaths  by  suicide  appears 
to  be  about  four  per  cent,  of  the  whole  deaths.     And  as  in  the  whole  of 
Fr(wce  the  proportion  of  registered  suicidal  deaths  equals  only  one  per 
cent.,  it  is  evident  that  three-quarters  of  these  deaths  escape  official  notice 
altogether. 

Dr.  Austin  Flint,  Jr.,  Editor  of  the  Bvffalo  Medical  Journal^  has 
been  appointed  to  the  chair  of  Physiology  and  Microscopic  Anatomy  in 
the  Medical  Department  of  the  University  of  Buffalo,  and  Dr.  Sanford 
Eastman  has  been  appointed  Professor  of  Anatomy  in  the  same  Uni- 
versity. 

Honors  are  falling  thick  on  iSir  Benj.  Bkodie,  states  a  recent  No.  of 
London  Medical  Thaes.  Last  week  he  was  elected  President  of  the  Me- 
dical Council;  this  week  President  of  the  Royal  Society.  He  stands  in 
a  higher  position  than  any  surgeon  has  ever  attained  in  this  country. 

Lunovic  HiKSCiiFiELD,  the  author  of  the  beautifully  illustrated  work  on 
the  nervous  system,  and  formerly  cJief  de  clinirjue  at  Hotel  Dieu,  Paris, 
has  been  nominated  Professor  of  Anatomy  at  the  Medico-Chirurgical  Aca- 
demy of  Warsaw. 

The  mortality  from  small-pox  has,  by  the  general  adoption  of  vacci- 
nation, been  reduced  from  its  proportion  of  1  in  ]0  of  the  entire  mort- 
ality, to  1  in  2,378. 

The  amount  of  Otto  Rose,  imported  by  England  during  the  four 
years  1854  to  1857,  inclusive,  was  over  eighty -six  thousand  ounces,  or  two 
tons  and  a  half. 

There  are  forty-two  Medical  Colleges  in  the  United  States;  from  which 
there  graduated,  of  the  Session  1858-9  over  fifteen  hundred^  from  an  army 
of  nearly  five  thousand  students. 

ScANzoNi  received  twenty-five  thousand  dollars  for  obstetrical  services 
to  the  Empress  of  Russia. 

In  a  town  of  Wurtemburg,  a  Mr.  Helgard  has  established  a  printing 
house,  which  is  carried  on  solely  by  160  deaf  and  dumb  individuals. 

It  is  suggested  that  when  doctors  fight  duels,  the  weapons  used  should 
be  pills. 


THE 


PENINSULAR  and  INDEPENDENT 


MEDICAL  JOURNAL. 


Vol.  II.  DETROIT,  AUGUST,  1859.  No.  6. 


rigiital  C0mmititiatiinis. 


ART.  XVIII.— Selections  from  Surgical  JTotes. 


By  Moses  Gunn  M.  D.,  Prof.  Surg,  in  the  University  of  Mich. 

Case  I.  A  Novel  Case  of  Strangulated  Femoral  Hernia. — 
September  12tli,  1857,  Mrs.  W.,  of  Oakland  Co.,  then  up- 
wards of  sixty  years  of  age,  required  an  operation  for  the 
relief  of  strangulated  femoral  hernia.  The  contents  of  the 
hernial  sac  had  been  down  for  ten  days,  during  which  period 
she  had  not  had  a  passage  of  the  bowels.  The  hernia  had 
existed  for  some  years,  but  was  of  moderate  size,  though  it 
had,  in  the  present  descent,  advanced  to  the  third  stage : 
viz.,  the  protruding  viscus  had  curved  forwards  and  up- 
wards, and  was  lying  over  Poupart's  ligament.  The  pa- 
tient was  suffering  at  times  from  violent  pain,  and  for 
two  days  had  vomited  stercoraceous  matter.  She  was  evi- 
dently failing  in  vital  power,  though  there  were  no  signs 
that  mortification  had  taken  place. 

Repeated  efforts  at  reduction  by  taxis   had   failed,  and 

Vol.  II.  — K. 


258  The  Peninsular  and  Independent. 

excited  exquisite  tenderness  of  the  parts ;  I  was  not  inclined, 
therefore,  to  renew  the  proceeding.  Kesort  was,  conse- 
quently, had  to  the  operation  of  dividing  the  stricture; 
this  was  made  in  the  usual  way,  the  steps  of  which  it 
is  not  necessary  to  repeat.  A  large  knuckle  of  intestine 
composed  the  whole  contents  of  the  hernial  sac ;  and  this 
was  very  much  congested,  though  in  no  degree  gangrenous. 

Immediate  relief  succeeded  the  operation.  Vomiting 
ceased,  and  a  pleasant  night's  rest  ensued.  An  aperient 
dose  of  castor  oil  was  ordered  the  next  morning.  Twelve 
hours  subsequently  (twenty -four  after  the  operation)  vomit- 
ing recurred,  and  soon  became  stercoraceous.  Injections 
were  ordered,  and  repeated  sundry  times,  but  without  ef- 
fect. The  vomiting  continued,  the  pulse  became  feeble  and 
frequent,  and  dissolution  seemed  at  hand. 

On  the  second  morning  subsequent  to  the  operation, 
no  evacuation  had  been  had,  and  the  patient  was  deemed 
moribund.  Shortly  after,  a  very  coj)ious  discharge  from  the 
bowels  took  place,  to  the  great  relief  of  the  patient,  who 
now  rallied,  and  became  convalescent.  This  was  on  Mon- 
day morning,  at  eleven  o'clock  —  forty -one  hours  subsequent 
to  the  operation.  Daily  evacuations  occurred  until  Satur- 
day, w^hen  the  wound  in  the  groin  re -opened,  and  a  fecal 
discharge  from  it  took  place !  During  the  balance  of  the 
patient's  life,  which  continued  for  a  year  longer,  with  a 
comfortable  degree  of  health,  evacuations  occurred,  both 
through  the  artificial  anus  and  jj^er  viam  natiiralem.  Dis- 
inclination, on  the  part  of  the  patient,  alone,  prevented  a 
resort  to  an  operation  for  the  relief  of  this  disgusting  con- 
dition of  the  groin. 

What  produced  a  recurrence  of  the  stercoraceous  vomit- 
ing, and  other  signs  of  strangulation,  after  the  relief  of  more 
than  twelve  hours  which  succeeded  the  operation.? — what  de- 
layed the  operation  of  the  cathartic? — what  was  the  patho- 
logic condition   which  finally  permitted   free   daily  evacua- 


GuNN's  Selections  from  Surgical  Notes.  259 

tionSj  find,  after  five  days,  resulted  in  a  re -opening  of  tlie 
wound,  and,  tlirough  it,  a  fecal  discharge  ?  —  are  questions 
which  afford  ample  opportunity  for  conjecture  ;  but  I  con- 
fess that,  as  yet,  I  have  been  unable  to  satisfy  my  own 
mind  as  to  the  truthfulness  of  any  which  has  been  suggested 
to  me. 


C/ASE  II.  Descent  of  a  Hernia  through  a  Congenital  Pas-' 
sage  for  the  first  time  cfter  Thirty  Years  of  Age. —  In  the 
fall  of  1848,  I  reduced,  by  taxis,  a  hernia  which  had  been 
down  some  fifteen  hours.  The  case  occurred  in  the  person 
of  a  medical  gentleman  of  (I  believe)  thirty -five  years  of 
age.  The  first  descent  of  the  hernia  had  occurred  only  two 
X)i'  three  years  previously.  There  was  nothing  remarkable  to 
%e  'observed  in  the  case.  On  the  12th  of  December,  1852, 
\  was  summoned  to  attend  the  same  patient  for  the  same 
malady.  This  time,  I  found  the  hernia  strangulated,  and 
the  patient  in  a  very  critical  condition.  I  did  not,  conse- 
quently, long  persist  in  efforts  to  reduce  by  taxis,  but  soon 
had  recourse  to  the  knife.  On  laying  open  the  sac,  which 
was  done  very  freely,  and  reducing  the  prolapsed  intestinCj) 
1  was  surprised  to  see  the  testicle  lying  very  cosily  in  the 
sac,  as  I  pushed  up  the  scrotum,  in  the  act  of  returning 
the  hernia !  On  examination,  the  hernial  sac  was  found  to 
be  composed  of  the  tunica  vaginalis; — in  fact,  the  anatomi'- 
cal  relations  were  identical  with  those  of  congenital  ingui- 
nal hernia.  The  hernia  had  occurred  by  the  descent  of  the 
intestine  through  a  congenital  passage.  Anatomically  con- 
sidered, it  was  a  congenital  hernia,  though  occurring  for  the 
first  time  after  the  patient  had  passed  the  thirtieth  year  of 
iige. 

After  the  descent  of  the  testicle,  it  is  probable  that  the 
connecting  passage  between  the  general  peritoneal  cavity 
and  the  tunica  vaginalis  had  become  very  greatly  narrowed, 
but   not,   as   is   the   natural  course,  completely  obliterated. 


260  The  Peninsular  and  Independent. 

Through  this  narrowed  passage,  the  hernia  was,  at  last^ 
forced ;  thus  producing  the  novelty  which  may  be  called  a 
congenital  hernia  occurring  after  thirty  years  of  age !  A 
hernia  is  termed  congenital  when  it  occurs  through  a  con- 
genital opening,  whether  it  exist  at  birth,  or  shows  itself  a 
week  subsequently.  The  difference  in  time,  in  this  case> 
was  only  the  trivial  little  matter  of  thirty  years. 
87  Shelby  St.,  June  18th,  1859. 


ART.  XIX.— A  "Criticism"  Criticised. 

By  0.  C.  GiBBs,  M.  D. 

A  VERY  amiable  M.  D.,  J.  A.  Brown,  of  Kankakee,  111., 
perpetrates  a  double  criticism,  at  our  expense,  of  some  ^^q 
pages,  in  the  June  No.  of  the  Peninsular  and  Independent. 
In  the  November  No.  of  that  very  excellent  monthly,  we 
reported  a  case  of  obstruction  of  the  bowels,  finally  over- 
come by  a  copious  enema,  that,  by  its  mechanical  action, 
we  supposed  replaced  an  intussuscepted  portion  of  intestine. 
Dr.  J.  A.  Brown  has  incubated  upon  that  case  for  six 
months,  and  finally  brought  forth  a  criticism,  which,  in 
spirit,  we  should  consider  wholly  unworthy  of  notice,  did 
not  our  Kankakee  friend  misunderstand  or  misrepresent  us. 
The  talented  critic,  with  great  condescension,  thinks  our 
article  was  ^^  well- intended,"  but  he  thinks  we  "seem  to 
manifest  more  of  an  inclination  to  say  something  in  the 
Journal  than  to  communicate  any  new  fact.''  Now,  for  the 
information  of  our  amiable  friend,  we  would  say  that  we 
made  that  report  as  short  as  was  consistent  with  a  well 
understanding  of  the  case, — omitting  many  minor  details ; 
our  object  being  simply  to  add  another  case  of  intussuscep- 
tion rectified  by  mechanical  pressure  from  below,  with  the 
intent  of  urging  an  earlier  resort  to  such  means,  instead  of 


GiBBS. — A  "  Criticism^''   Criticised.  261 

trusting  to  worse  than  useless  cathartics,  wiiich  our    critics 
advise  to  the  contrary  notwithstanding. 

May  we  be  permitted  to  inquire  what  ^^new  fact"  Dr. 
Brown's  five  pages  are  calculated,  or  rather  intended,  to 
impart.^  After  searching  it  carefully,  we  can  see  none, 
save  that  he  has  self-conceit  enough  to  suppose  that  he,  in 
his  wisdom,  is  better  qualified  to  diagnosticate  and  prescribe 
for  a  case  hundreds  of  miles  away,  than  we,  with  the  patient 
before  us,  aided,  as  we  were,  by  the  best  counsel  in  West- 
ern New  York. 

As  the  Doctor  is  somewhat  exercised  over  what  seems 
to  him  our  vain  desire  to  appear  in  print  with  nothing  to 
say,  we  trust  we  may  be  permitted  to  refer  him  to  files  of 
Bankings  Abstract,  Braithwaite's  Retrospect,  The  British 
and  Foreign  Medico  -  Chirurgical  Beview  ;  the  editors  of 
which  journals  have  been  silly  enough  to  consider  some  of 
our  "well -intended"  articles  as  worthy  of  being  re -printed 
in  their  respective  journals.  If  Dr.  Brown  will  send  those 
weak-headed  editors  his  criticism,  they  will  doubtless  repeat 
that  foolish  thing  no  more.  • 

We  pass  over  the  criticism  upon  our  first  article,  re- 
marking, simply,  that  if  Dr.  DuBois  felt  himself  aggrieved 
by  our  article,  he  is  abundantly  able  to  defend  himself 
We  then  disavowed  all  intent  to  criticise — making  Dr.  Du- 
Bois's  article  a  text  for  a  few  remarks  of  our  own — never 
dreaming  that  every  medical  article  must  suggest  a  new 
remedy.  Did  it  never  occur  to  our  learned  critic,  that, 
though  Doctors  agree  in  regard  to  the  proper  remedies  in 
a  given  case,  they  Jaay  honestly  difier  in  regard  to  their 
proper  use  ? 

Our  critic  makes  merry,  and  puts  in  requisition  a  few 
unnecessary  exclamation  -  points,  because,  from  the  appear- 
ance of  the  patient  and  the  general  symptoms,  we,  at  first, 
and  before  a  full  examination  of  the  case,  suspected  stran^ 
gulated  hernia.     If  Dr.  Brown  has  never  seen  or  heard  of 


262  The  Peninsular  and  Independent. 

cases  of  strangulated  hernia,  where  the  patient  was  ignorant 
of  the  fact,  or  unwilling  to  confess  it,  he  had  better,  in  our 
judgment,  lay  by  his  pen- critical  and  resume  his  study  of 
elementary  works.  In  the  very  first  work  we  lay  our  hands 
upon,  we  find  the  following : 

"In  every  case  of  sudden  and  violent  vomiting  and  cholic,  the  bend 
of  the  thigh  should  be  well  examined,  and  inquiries  should  be  made  for 
any  tumor  about  the  abdomen — hecaufte  the  patient  may  hate  been  lobar- 
ing  under  hernia  for  ycarSy  and  yet  from  ignokance  or  mauvam 
honte,  may  not  mention  it." 

Had  Dr.  Druitt  been  as  wise  as  our  Kankakee  critic,  he, 
probably,  never  would  have  penned  so  foolish  an  item  of 
direction. 

With  a  flourish,  our  critic  wants  to  know — 

"What  tyro  in  medicine,  .  .  .  would  not  readily  hsiYe  predicted 
[diagnosticated  is  the  word]  the  real  difficulty,  viz.,  penitoncal  inflamma- 
tion"? 

For  the  benefit  of  our  learned  friend,  we  confess  we  were 
just  the  tyro  that,  at  Jirst,  could  do  no  such  thing.  The 
bowels  were  soft  and  painless^  excej^ting  a  spot  that  could  be 
covered  with  the  palm  of  the  hand,  in  the  region  of  the 
ilio-  cgecal  valve.  We  could  not  diagnosticate  intussusception 
even,  for  we  lacked  the  evidence ;  but  we  did  diagnosticate 
inflammation  of  that  limited  i^ortion  of  the  intestine  deno- 
minated the  caecum,  and  predicted  obstruction. 
With  another  flourish,  our  critic  asks  : 


■•? 


"What,   we  ask,    in   the  name  of  reason,        ild   it  have   been   but 


peritonitis  ?  " 


Guided  by   such   reason   as   is"  vouchsafed   to   us,  we  have 
re<>;istered  our  omnion  above. 

Our  critic  finds  fault  with  us  for  giving  opium  at  first^ 
instead  of  bleeding  and  giving  an  ^^-^fficient  and  reliable- 
cathartic."     Supposing  the  case  to  have  been  peritonitis,  as, 


# 


GiBB3.  —  A  '-'■  CriticisnV'^   Criticised.  263 

Dr,  Brown  supposes.  Dr.  Watson  condemns  cathartics  at 
first  in  such  cases,  and  quotes,  in  illustration,  a  case  nearly 
cured  by  opium,  in  the  hands  of  the  celebrated  Dr.  Stokes, 
and  finally  killed  by  a  cathartic,  and  remarks  : 

"This  example  puts  in  a  very  strong  light  the  good  effects  of  opium, 
and  the  dangerous  effects  of  2^urgatives.^^ 

But  Dr.  Watson   was   but   a   rush -light,    when   compared 
with  our  Kankakee  medical  luminary. 

Will  Dr.  Brown   remember  that   our  patient  was   ad- 
vanced in  years  ;  that  the   countenance  was  haggard  ;  that 
she  was  extremely  prostrated  ;  pulse  weak,  soft,  and  120  per 
minute.^     Bleeding  was  not  not  to  be  thought  of,  at  least 
general   bleeding.      The  Dr.  would  do  well  also  to  remem- 
ber that  vomiting  was  a  prominent  symptom  from  the  first 
— severe  and  persisting — soon  becoming  stercoraceous,  and 
continuing  until  the  obstruction  was  overcome.     In  such  a 
case,  active  cathartics  would  only  have  increased  the  patient's 
Bufierings,  aggravated    all    the    symptoms,    and    greatly   in- 
creased the  hazard.     In  such  cases.  Dr.  Watson  says,  ^'  To 
persist  in  the  use  of  drastic  purgatives,  is  to  inflict  wanton  and 
needless  torture  upon  the   patient."     In  our  humble  judg- 
ment, if  there    was    intussusception,    cathartics   were  worse 
than  useless ;  and,  if  not,  our  best  hopes  lay  in  first  quiet- 
ing  the  stomach,    so   that   it   would   not  reject   an   efficient 
cathartic.      If  our   critic  knows  of  anything  better  for  the 
accomplishment  of  this  end  than  opium  with  small  doses  of 
calomel,   will   he   please   oblige   us  with    the   result  of  his 
experience. 

Our  critic  seems  to  forget  that  cathartics,  consisting  of 
an  infusion  of  senna  and  salts,  were  repeatedly  given  per 
rectum.  Dr.  Brown  charges  us  with  neglecting  the  use  of 
efficient  cathartics.  When  every  means  failed  to  procure 
relief,  and  death  was  imminent,  though  we  were  firm  in  the 
faith  that  we  had  a  case  of  intussusception  to  deal  with,  and 


264  Hie  Peninsular  and  Independent. 

as  in  that  case  hope  was  almost  null,  we  were  bound  to  hope 
at  least  that  our  diagnosis  might  be  wrong,  as  a  dernier  resort ^ 
with  death  staring  us  in  the  face,  we  gave  the  cathartic 
powers  of  calomel  a  full,  and  even  rash,  trial.  If  we  rightly 
remember  (we  have  sent  the  Peninsular  and  Independent, 
for  1858  away  to  be  bounds  and  have  not  our  article 
before  us),  ten  grains  of  calomel  were  given  every  three  or 
four  hours,  for  two  days.  What  more  would  our  friend 
require  of  us  ?  In  our  judgment,  this  would  have  been 
imprudent  and  uncalled-for  at  first,  but  was  justifiable  at 
the  time  such  treatment  was  brought  in  requisition.  Our 
physicking  advocate  should  remember  that  even  this,  aided 
by  purgative  enemata,  failed  entirely  to  produce  alvine 
evacuations,  until  the  intussusception  was  removed  by  me- 
chanical means,  which  our  critic  vaguely  insinuates  was 
inhuman.  To  this  insinuation,  we  oppose  our  humble  con- 
viction that  the  purgatives  which  he  so  strongly  urges, 
were  worse  than  useless,  and  if  anything  deserved  such  a 
cognomen,  that  treatment  was  most  certainly  it. 

To  show  Dr.  Brown's  unfairness,  to  say  nothing  of 
dishonesty,  we  make  the  following  quotation,  in  which  he 
says  we 

'"'' ns^ii  solid  ojnum  for  three  or  four  days  together^  with  little  or  nothing 
else;  and  indeed,  nothing  else  in  anything  like  sufficient  quantities  to 
produce  catharsis." 

Now,  on  the  second  day  (not  the  fourth),  we  said,  '^  The 
treatment  was  continued,  the  opium  in  diminished,  and  the 
calomel  in  increased  doses."  From  aught  that  is  stated, 
and  for  aught  that  Dr.  Brown  knows,  calomel  might  (though 
we  aver  it  was  not)  have  been  used  in  teaspoonful  doses, 
so  early  as  the  second  day ;  yet  our  fair,  honorable,  and 
learned  critic  avers — upon  what  authority  we  know  not  — 
that  for  four  days  we  used  nothing  but  solid  opium  ! 

Dr.  Brown  flourishes,  with  manifest  satisfaction,    what 
he   supposes   is   an  inconsistency,   and  exclaims:    '^Now,  is 


GiBRS. — A  '•'•  Criticism'^^   Criticised.  265 

there  not  great  incongruity  just  here  V      We  answer  Yes, 
in  the  critic's  conception,  not  in  our  statement. 

The  difficulty  was  a  local  intestinal  inflammation,  caused 
by  the  intussusception  at  first,  and  it  is  not  improbable 
(which  is  all  that  was  stated)  that  the  local  inflammation 
extended  to  the  peritonaeum,  and,  in  time,  became  more  or 
less  general  peritonitis.  When  the  cause,  the  intussuscep- 
tion, was  removed,  the  consequences  had  progressed  beyond 
the  point  of  curability.  Our  obtuse  perceptions  fail  to  see 
the  incongruity. 

To  the  no  small  discomfiture  of  Dr.  Brown,  we  would 
say  that  the  patient  experienced  none  of  the  peculiar  effects 
of  opium  ;  it  is  probable  that  it  was  nearly,  if  not  entirely 
rejected  by  the  fre(][uent  and  persistent  vomiting.  "Large 
linseed  cataplasms,  saturated  freely  with  the  oleum  terabin- 
thence,"  were  early  and  persistently  used.  Our  critic  says, 
if  we  had  resorted  to  '^copious  blood-letting  and  a  brisk 
cathartic''  early,  "  the  result  might  have  been  different."  Of 
this  we  have  no  doubt — the  patient  might  have  died  sev- 
eral days  sooner  I  As  somewhat  explanatory  upon  this 
point,  we  would  say  that  for  the  last  three  years,  in  this 
locality,  all  diseases  have  assumed  a  typhoid  type.  Pneu- 
monia, for  instance,  has  only  been  successfully  treated 
without   blood-letting,    and   with  the   early   use    of  quinia. 

Asking  pardon  of  your  readers  for  occupying  so  much 
time  and  space,  we  now  take  leave  of  Dr.  Beown,  kindly 
reminding  him  that,  before  he  attempts  another  criticism, 
there  is  an  old  adage  that  it  would  be  well  to  remember— 
"  Be  sure  you  are  right,  and  then  go  ahead.'' 

Prewsburg,  N.  Y. 


266  The  Peninsular  and  Independent. 


ART.  XX.— Two  Cases  of  Strangulated  Hernia :  Operation  and 

Result. 


By  Z.  E.  Bliss,  M.  D. 


Case  I.  Strangulated  Inguinal  Hernia  of  Left  Side :  Ope- 
ration and  Recovery. — February  4tliy  1859,  I  received  a  note 
from  my  friend  Dr.  Cornell,  requesting  my  assistance  in 
a  case  of  strangulated  hernia.  My  friend  Dr.  Wilson 
consented  to  accompany  and  assist  me.  We  found  the 
patient,  Mr.  E ,  laborer,  aged  4.5,  suffering  from  a  stran- 
gulated inguinal  hernia  (oblique)  of  the  left  side,  of  thirty- 
six  hours'  standing. 

Previous  History. — Twenty  years  ago  received  a  fall, 
producing  hernia  on  either  side  ;  has  never  wore  any  sup- 
port but  a  bandage  and  compress,  and  at  intervals  nothing^ 
Three  years  ago,  the  intestine  came  down,  and  becoming 
strangulated,  his  physician,  Dr.  Cornell,  by  bleeding,  ice 
locally,  and  taxis,  succeeded  in  reducing  it. 

Condition  Thirty -six  Hours  after  Strangulation  com- 
menced.— Kestless,  pulse  one  hundred,  occasional  stercora- 
ceous  vomiting,  countenance  anxious  ;  scrotal  tumor  of  left 
side,  ten  inches  in  circumference,  somewhat  elastic,  dis' 
colored,  and  tender  to  the  touch. 

Taxis  had  been  thoroughly  tried  three  times,  with  patient 
under  the  influence  of  chloroform  ;  anodynes  internally,  and 
ice  to  the  tumor,  xifter  a  consultation,  the  patient  was 
placed  in  a  proper  position,  chloroform  given,  and  uninter- 
rupted taxis  continued  for  one  hour,  with  no  perceptible 
change  in  the  tumor.  After  a  second  consultation,  the 
patient  was  given  time  to  rally,  and  again  placed  under  the 
influence  of  chloroform,  at  which  time,  being  assisted  by  the 
above  named  gentlemen,  I  made  an  incision  three  and  one- 
half  inches  in  length,  corresponding  with  the  upper  border 
of  Poupart's  ligament,  and  dissecting  (by  an  artificial  light) 
down    to   the   sack,    opened   it,    and   a   quantity   of    serum 


Bliss'   Cases  of  Strangulated  Hernia.  267 

escaped.  The  intestine  presented  a  dark  purple  surface. 
The  stricture  being,  divided,  two  or  three  bands  of  adhe- 
sion were  found  between  the  neck  and  stricture,  at  the 
lower  and  inner  border,  which  being  broken  up,  the  tumor 
was  returned. 

A  few  stitches,  cold  water  dressings,  and  a  compress ^ 
completed  the  whole,  and  I  left  him  in  charge  of  his  phy- 
sician ;  who  has  since  informed  me  that  anodynes  were  given^ 
and,  on  the  fourth  day,  the  dressings  were  for  the  first  time 
removed,  when  union  by  first  intention  had  taken  place 
through  nearly  the  whole  wound,  and  on  the  same  day 
there  was  a  spontaneous  movement  of  the  bowels.  No 
unpleasant  symptoms  occurring,  in  three  weeks  he  was  able 
to  resume  business.  He  was  directed  to  wear  a  compress 
for  several  months. 


Case  II.  Strangulated  Femoral  Hernia  of  Right  Side : 
Operation,  and  Death. — June  11th,  1859,  I  received  a 
summons  to  meet  Drs.  Dodge,  of  Palo,  and  Leonard,   of 

Greenville,  in  consultation,  at  the  residence  of  Mr.  B- -, 

in  Montcalm  county. 

Mr.  B ,  aged  42,  a  laborer,  says  a  tumor  has  made 

its  appearance  in  the  right  groin,  at  intervals  for  the  last 
seventeen  years.  June  9th,  he  had  been  lifting,  heavily,'' 
the  tumor  came  down,  appeared  larger,  and  became  painful. 
His  physicians  were,  sent  for,  and  the  usual  means  of 
reduction,  such  as  taxis  with  its  auxiliaries,  cold  to  the 
tumor,  anodynes  internally,  and  tobacco  enema;  but  all 
availed  nothino^. 

I  first  saw  the  patient  fifty  hours  after  the  commence- 
ment of  strangulation,  countenance  sunken  and  expressive  of 
great  anxiety  and  sufi"ering,  pulse  125,  and  occasional  ster- 
coraceous  vomiting.  The  tumor,  fi^e  inches  in  circumfer^ 
ence,  lay  over  Poupart's  ligament. 

As   the  strangulation   was   of  long  duration,  and   taxis 


268  The  Peninsular  a7id  Independent. 

had  been  thorougbly  tried,  an  operation  was  deemed  the 
only  alternative.  Accordingly  ether  and  a  little  chloroform 
was  given,  to  full  anaesthesia,  and,  assisted  by  the  above 
mentioned  gentlemen,  I  proceeded  making  an  incision,  about 
three  and  one -half  inches  in  length,  corresponding  with  the 
inferior  border  of  Poupart's  ligament,  and,  dissecting  up 
the  different  layers,  exposed  the  sack,  and  opening  it  found 
firm  and  extensive  adhesions  between  it  and  its  contents^ 
which  was  not  further  disturbed.  The  stricture  was  divided? 
also  the  sac  at  the  seat  of  stricture  ;  and  there  being  no 
contra -indications,  the  whole  was  reduced.  At  this  stage, 
the  extremeties  became  cold,  and  their  arteries  pulseless  ;  a 
cadaveric  countenance,  abdominal  respiration,  and  slow  pul- 
sation of  the  carotids,  all  told  too  plainly  of  what  was  likely 
very  soon  to  follow.  A  current  of  air,  ammonia  to  the  nostrils, 
dashing  of  cold  water  upon  the  face  and  chest,  alternated  with 
friction  and  flagellation,  and  friction  to  the  extremities, 
were  instantly  resorted  to,  but  the  patient  ceased  to  breathe. 
Makshal  Hall's  ready  method  was  now  tried,  and  contin- 
ued with  the  above  mentioned  auxiliaries,  for  eight  or  ten 
minutes,  when  I  had  the  good  fortune  to  see  the  patient  rally, 
who,  without  this  timely  means,  must  have  died  under  the 
operation.  A  few  stitches  were  made,  and  a  compress  and 
cold  water  dressings  applied  to  the  wound.  In  one  hour, 
the  patient  had  sufficiently  rallied  to  express  himself  com- 
fortable ;  pulse,  ^^. 

I  left  him  in  charge  of  his  physician.  Stimulating  doses 
of  morphine  were  to  be  given  every  two  or  four  hours  ;  and 
if  he  sank,  brandy  and  opium. 

The  following  is  from  Dr.  Dodge  :  Three  hours  after  the 
operation,  pulse  70,  and  fuller.  One -eighth  grain  of  morphia 
acetat.  Patient  fell  asleep,  and  in  three  hours  awoke  with 
great  prsecordial  distress  ;  pulse  rapid  and  feeble.  Brandy 
and  opium.  Patient  sank  rapidly,  and  in  three  hours  (it 
being  nine  after  the  operation,  and  fifty  -  nine  from  the  com- 
mencement of  strangulation)  expired. 


Bliss'    Cases  of  Strangulated  Hernia.  269 

It  is  quite  likely  that  this  man  died  from  peritonitis,  or 
from  the  shock  to  the  system  occasioned  by  the  operation  ; 
but  probably  from  both.  I  think  that  a  single  incision  is 
quite  sufficient  for  all  practicable  purposes,  and  gives  ample 
room  for  all  necessary  manipulations  around  the  neck  of  the 
sac  (provided  the  tumor  is  not  large  —  and  which  we  know 
is  seldom  the  case  in  Femoral  Hernia),  thereby  doing  less 
injury  to  the  parts,  and  leaving  less  surface  to  unite. 
Ionia,  June  29th,  1859. 


ART.  XXI.— Treatment  of  Chronic  Conjunctivitis— A  lew  Agent. 


By  F.  Rice  Waggoner,  M.  D. 

Chronic  Conjunctivitis,  when  a  sequel  of  an  acute  inflam- 
mation, is  of  indefinite  duration.  In  our  Prairie  State  and 
southwestern  district,  we  frequeDtly  meet  with  cases  of  three, 
four,  and  five  years'  duration,  and  not  unfrequently  it  runs 
into  tens  of  years.  In  all  cases,  the  conjunctiva  is  gran- 
ulated^  and  more  or  less  thickened.  In  one  case  that  came 
under  my  observation,  the  conjunctiva  and  lids  were  thick- 
ened to  twice  their  normal  condition :  the  case  being  one  of 
thirty -five  years'  standing.  As  every  practitioner,  who 
has  tried  his  skill  upon  it,  too  well  knows,  this  form  of 
Ophthalmia  is  one  very  difficult  to  treat  successfully,  and 
often  he  is  pained  to  see  his  patients  fall  into  the  hands  of 
unmerciful  quacks,  to  have  their  eyes  injured  tenfold,  and 
their  pockets  drained  of  often  hard  earnings. 

During  my  papilage,  I  was  taught  a  mode  of  treatment 
not  common  to  the  "  books,"  nor  do  I  think  to  the  Profes- 
sion at  large,  which  I  desire  briefly  to  submit. 

Treatment. — After  correcting  their  general  health,  if  de- 
ranged, I  require  my  patients  to  attend  my  office  twice  per 
day,  morning  and  evening.     First  application  is  a  small  (one 


270  The  Peninsular  and  Independent. 

sixteenth  of  a  grain)  quantity  of  sulph.  morphine,  dissolved 
in  pure  water,  and  applied  with  a  earners  hair  brush  ;  this 
treatment  to  be  continued  for  one  or  two  days,  until  al^ 
irritability  is  allayed.  In  turn  follows  acetat.  plumbi,  sulph, 
zinci,  acetat.  zinci,  sulph.  cupri,  and  nit.  argent.  This  con- 
stitutes my  Materia  Medica. 

Experience  has  taught  me  that  the  mucous  membrane 
of  the  eye  will  not  tolerate  any  one  application  more  than 
twice  or  thrice  without  positive  damage  to  the  organ  dis- 
eased ;  hence  the  secret  of  successful  treatment. 

In  the  application  of  our  remedies,  the  milder  astrin- 
gents should  be  used  until  the  active  phlogosis  is  all  sub- 
dued ;  then  follow  with  the  more  active  agent,  which  should 
be  applied  with  care,  ancl  never  be  so  strong  as  seriously  to 
irritate  the  organ  ;  but  use  them  generally  in  succession^ 
governed  by  the  stage  of  the  inflammation,  when,  sooner  or 
later,  our  patient's  malady  progresses  to  a  termination — gene- 
rally within  six  or  eight  weeks. 

The  case  referred  to  in  this  article  who  had  been  a  sub- 
ject of  the '^  sore  eyes"  for  the  majority  of  her  days,  was 
treated  by  me  on  this  alternating  plan,  and  a  cure  effected 
in  ten  weeks. 

Latterly  I  have  incorporated  in  my  Materia  Medica  the 
iodide  of  zinc,  the  effects  of  which  have  proved  salutary 
beyond  all  anticipation.  This  drug  is  passed  over  in  all  of 
our  standard  works  on  Therapeutics,  in  almost  profound 
silence.  In  no  case,  in  which  I  have  observed  its  effects  in 
the  treatment  of  Ophthalmia,  has  it  deserved,  in  my  humble 
opinion,  a  place  second  to  any  other  remedy.  In  one  scro- 
fulous case,  it  acted  like  a  charm. 

Will  not  the  Profession  give  attention  to  this  very 
deserving  agent,  and  more  fully  prove  its  worth  ? 

Oconee,  111. 


HoRTOisr's  Meteorological  Register  for  June, 


211 


ART.  XXII.  —  Meteorological  Register  for  Montli  of  June,  1859. 
By  L.  S.  Horton,  House  Physician  to  U.  S.  Marine  Hospital. 

AUitude  of  Barometer  above  the  level  of  the  sea,  597  feet.     Latitude,  420  24'N,;  and 
Longitude,  82*58'W.  of  Greenwich. 


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MEDICAL  HEROISM.  Address  before  the  Philadelphia  County  Medi- 
cal Society.  Delivered  February  24th,  1859,  by  John  Bell,  M.  D., 
at  the  close  of  his  official  term  as  President.  Published  by  order 
of  the  Society.     Philadelphia.     1859.     38  i^p. 

Medical  Heroism  !  Is  there  really  such  a  thing  ?  The 
world  knows  nothino^  of  it.  Who  ever  talks  of  such  a  thino^  ? 
Who  ever  disconnects  the  idea  of  heroism  from  feats  of 
"  broil  and  battle"  ?  Who  ever  thinks  of  seeking  for  true 
courage  in  the  much  despised,  often  ridiculed,  and  very  gene- 
rally unrequited  vocation  of  the  Medical  Practitioner  ?  Does 
History,  in  the  discharge  of  her  duties,  rake  up  for  record 
instances  of  heroism  from  such  a  despised  source  ?  Does 
the  Novelist,  as  he  ransacks  history,  or  scrutinizes  society 
from  palace  to  hovel,  for  material,  ever  dream  that  "Doctor" 
of  his  story  can  figure  in  any  other  than  a  ridiculous  atti- 
tude ?  Is  there  truly  anything  in  the  actions  of  medical 
men  that  is  heroic?  Is  the  "Doctor"  ever  the  hero  of 
anything  save  a  nauseous  draught  or  a  petty  professional 
quarrel  ?  Alas !  that  the  world  generally  can  ask  these 
questions  in  the  utmost  sincerity.  Alas  !  that  the  Profes- 
sion must  sound  its  own  praise,  or  never  hear  it.  Alas  ! 
that  it  was  necessary  for  our  author,  in  addressing  his 
brethren  upon  the  subject  of  Medical  Heroism,  to  hold  the 
language  that  he  does. 

Medical  Heroism  is  not  a  myth.     Every  practicing  phy- 
sician has   often   braved   danger,   without    hope    of  reward, 


Bibliographical  Record.  273 

cither  in  money  or  fame.  But  it  is  not  strange  that  the 
world  does  not  fully  appreciate  this  fact.  It  is  too  common 
to  be  noticeable.  But  when  pestilence  walketh  abroad,  and 
startled  comuunities  fly  from  the  scene  of  danger  and  death 
— when  ties  of  friendship  or  bbod  are  not  strong  enough 
to  retain  the  fleeing  one,  to  smooth  the  dying  couch  and 
administer  the  cup  of  water  to  the  loathsome  relic  of  friend 
or  brother — who  stand  firm,  and  faithfully  discharge  duties 
which  are  now  heroic  in  their  nature  ?  Not  only  so  ;  but 
when  the  ranks  of  these  brave  men  are  thinned  by  the 
enemy  which  they  so  determinedly  battle,  who  step  in  ta 
take  their  places  ?  Who  leave  home  and  friends,  to  fly  to 
the  rescue  ?  Medical  Men.  Is  it  not  strange  that  such 
deeds  do  not  live  in  history  ?  Perry  lives  m  the  hearts  of 
his  countrymen,  and  monumental  fame  will  be  his ;  but 
will  admiration  or  gratitude  ever  call  up  and  perpetuate  the 
names  of  those  brave  men  who  volunteered  and  fought  the 
cholera  in  Sandusky,  with  a  courage  unsurpassed,  and  a 
determination  in  which  ^' Do  n't  give  up  the  ship"  was 
written  in  acts  of  love  and  mercy  ?  The  two  are  neighbor- 
ing scenes :  one  is  already  sacred ;  will  the  other  ever  become 
so  .^  Will  the  Medical  Heroes  of  Norfolk  live  in  history  ? 
Yet  deeds  of  bravery  were  there  enacted  such  as  were  never 
witnessed  on  battle-field.  No  short-lived  excitement  moved 
those  men,  but  for  weeks  they  coolly  faced  the  enemy, 
mitil  they  finally  fell  in  action,  or  were  permitted  to  share 
in  victory. 

But  let  us  hear  from  Dr.  Bell  himself 

The  medical  hero  in  Christian  lands  is  not  to  be  sought  for  in 
courts  or  in  camps,  nor  in  the  busy  and  crowded  haunts  of  the 
wealth- seeking ;  he  is  not  on  the  Rialto  or  the  Exchange,  nor  promi- 
nent at  the  polls  ;  he  is  neither  a  demagogue,  inflaming  the  passions 
of  the  multitude,  nor  a  parasite,  flattering  the  prejudices  of  the  rich, 
or  ministering  to  the  caprices  of  those  in  power.  He  seldom  finds  a 
place  in  pageant  or  in  festival ;  seldom  is  called  upon  to  add  his  voice 
to  the  peans  of  victory.  He  passes  through  the  crowd  often  unknown 
Vol.  II.  -  S. 


274  The  Peninsular  and  Independent. 

uncarcd  for,  unless  indeed  it  may  be  when  he  meets  the  face  of  one 
radiant  'uith  Fmilcs,  whom  he  had  visited  but  a  short  time  before, 
pi'ostratc  on  the  bed  of  sickness,  or  hears  his  name  uttered  by  another 
in   a  tone  equivalent  to  saying,    "God  bless  him!" 

But  in  what  terms,  by  wliat  epithets  shall  wc  designate  him  who, 
without  any  such  genial  incentives,  without  any  expectation  of  possi- 
ble reci[)rocity,  or  hope  of  applause,  and  certainly  without  any  of  ihc 
returns  for  self-  exposure  which  men  might  expect  fiom  men,  goes 
about  from  day  to  day,  and  often  too  in  the  silent  watches  of 
the  rn'ght,  in  a  spirit  of  self-sacrifice  of  case,  comfort,  health,  and  life 
itself,  ministering  lelicf  to  his  pestilence -stiicken  and  fever  -  tossed  fel- 
low-creature, the  inmate,  it  may  be,  of  a  garret  or  a  cellar  of  sorao 
wretched  tenement,  in  an  affected  court  or  alley,  the  approich  to  which 
is  by  a  narrow  passage,  obstructed  by  accumulations  of  all  kinds  of 
refuse  and  impurities?  Is  this  man  a  soldier,  inured  to  scenes  of  car- 
nage and  death,  whose  vocation  makes  him  regardless  of  danger,  and 
who,  although  he  may  be  detailed  on  the  f>il()rn  hope,  knows  that  if 
he  fall,  his  name  will  bo  recorded  in  ihj  Gazette,  and  his  wife  and 
children  receive  perhaps  a  pension  ?  Or  is  he  a  salaried  official,  who, 
for  a  certain  pecuniary  return  and  perquisites,  is  discharging  a  pre- 
scribed and  covenanted  duty  ?  Oh,  no!  This  simple- minded  man,  who 
goes  about  his  duty  for  duty's  and  humanity's  sake,  is  only  a  doctor^ 
one  of  a  class  at  whom  every  wittling  is  privileged  to  fling  a  sarcasm, 
and  whom  every  venal  quack  may  accuse  of  selfishness,  and  greediness 
of  gold. 

"  During  the  famine  fever  of  18-47  in  Ireland,  one  hundred 
and  seventy  -  eight  Ii  ish  medical  practitioners,  exclusive  of  medical 
pupils  and  army  surgeons,  died,  being  a  proportion  of  nearly  seven  per 
cent.,  or  one  in  ever}-  ] -5  medical  practiiioners,  in  a  single  year.''  Some 
persons  may  say  that  physicians  who  thus  expose  themselves,  and  who 
pay  tl.c  penally  of  death  for  their  exposuie,  rre  encouraged  by  the  ex- 
pectation of  pecuniary  advantage  in  the  v'-hapc  of  fees.  We  must  all 
wish  that  they  had  such  inducements ;  the}'  could  readily  afford  to 
forego  a  part  of  their  reputation  f(^r  benevolence  and  disinterestedness, 
in  cjnsidcration  of  their  receiving  that  by  which  they  could  support 
their  wives  and  children,  or  an  aged  parent,  or  a  lone  sister.  But  it 
ro  happens,  that  in  all  c[)idemic  and  pestilential  diseases,  the  chief  pri- 
vations and  dangers  incurred  by  medical  men  are  in  their  attendance 
on  the  poor,  the  nced\^  and  the  destitute,  and  not  seldom  the  dissolute, 
who  have  no  claim  on  them  by  prioi-  acquaintance  or  the  most  tiivial 
scivice,  and  from  whom  they  receive  no  fees,  and  often  no  thanks,  or 
the  slightest  token  of  gratitude. 

The  greater  part  of  the  mortality  among  the  Irish  physicians  was 
caused    by    their    attendance   on  hospitals,    and    on    the    poor  and  half- 


Blhllographical  Record,  275 

starved  occupants  of  cabins  and  haralets,  the  air  of  which  was  often 
in  such  a  state  of  concentrated  virulence  as  to  strike  on  the  Dcrvous 
S3"stcm  with  almost  the  force  and  suddenness  of  the  electric  aura.  And 
shall  no  page  in  histor}'',  no  lines  in  poetr}'',  celebrate  the  heroic  deeds 
of  these  devoted  men,  who  must  have  battled  with  a  stouter  heart 
against  an  unseen  enemy  than  Lt:0NiDAS  and  his  Spartan  band  against 
the  Persian  host,  or  the  Light  Brigade  in  its  daring  and  rash  charge 
on  the  scried  Russian  lines  at  Inkermann  ?  These  heroes  of  humanity 
ought  to  be  honored  with  a  monumental  inscription,  even  though  it 
were  couched  in  as  brief  phrase  as  that  over  the  remains  of  the  Athe- 
nians under  Miltiades  — 

"They  fought  at  Mi'ralbon." 

Dr.  Bell  alludes  also  to  the  New  York  physicians  who 
fell,  a  few  years  since,  in  attending  upon  newly -arrived  emi- 
grants, lie  refers  at  length  to  the  plague  of  Marseilles  in 
1720,  and  the  yellow  fever  of  Philadelphia  in  1793.  Of 
Dr.  BenjaiuIN  Eush,  who  was  active  in  the  latter,  he 
says  : 

In  the  history  of  the  war  of  tho  Revolution,  Dr.  Benjamin  Rush, 
RS  one  of  the  signers  of  the  Declaration  of  Independence,  and  Phj^sician' 
General  to  the  army,  will  ahvaj^s  iigurc  with  the  other  worthies  of  that 
momentous  period.  But  in  the  history  of  philanthropy  he  will  occupy 
a  still  higher  place,  as  one  of  the  medical  heroes  who  won  his  honors 
and  enduring  fame  in  the  trying  year  of  1793,  and  in  the  other  epi- 
demic invasions  of  the  yellow  fever  during  the  next  twelve  years.  The 
fever  of  1798  revived  the  terrors  and  the  mortality  of  1793,  and,  at 
the  same  time,  gave  opportunities  for  a  display  of  heroic  devotcdness 
on  the  part  of  the  physicians  similar  to  that  manifested  in  the  latter 
year. 

The  following  selections  contain  a  good  illustration  of 
the  difference  in  the  courage  which  is  shown  on  the  battle- 
field and  that  which  faces  pestilence  ;  and  also  a  fine  in- 
stance of  courage,  devotion,  and  zeal : 

Slill  more  animated  must  have  b:ea  the  feeling  of  the  whole  French 
army  in  Egypt  under  Napoleon,  or,  as  he  was  then  more  common'y 
calletJ,  Bl'onap\ute,  towards  the  chiefs  of  the  medical  and  surgical 
staff.  The  troops,  after  witnessing  the  ravages  of  the  plague,  became 
alarmci  and  dishcarttncd ;  and  m.en  v.ho  had  never  feared  an  enemy  in 
Xhc  field  of  battle,   now  shrank  with  horror  from  the  touch  and  breath 


276  The  Peninsular  and  Independent. 

of  a  sick  companion  in  the  quiet  tent.  To  the  General,  such  a  state  ot 
things  was  worse  than  the  loss  of  a  battle.  In  vain  were  the  soldiers 
told  that  their  fears  were  without  foundation  ;  in  vain  were  they  ad- 
dressed in  the  language  of  encouragement  and  hope.  Something  must 
be  done,  cither  to  change  their  belief  or  to  appeal  strongly  to  their 
imagination.  Accordingly,  Napoleon  himself  conversed  freely  with  tho 
patients  who  were  stricken  with  the  plague,  and  touched  their  bodies, 
and  even  sometimes  performed  the  part  of  a  nurse  by  raising  them  up. 
and  supporting  them  in  their  beds,  in  order  to  prove  that  there  was. 
no  danger,  and  that  the  disease  was  not  contagious.  These  traits  of 
cool  courage  are  recorded  by  every  historian  of  the  wars  of  the  French 
Revolution  ;  but  few  have  thought  it  worth  while  to  notice  the  more 
daring  exploit  of  Dksoenettes,  one  of  the  physicians  of  the  army  of 
Egypt.  He  not  only  touched  and  handled  the  bodies  of  those  who  had 
sickened  with  the  plague,  but  he  inoculated  himself  with  their  blood 
and  other  iluids.  On  another  occasion,  after  Beuthollet  had  expressed 
his  belief  that  the  poison  of  the  plague  was  conveyed  into  the  body 
by  means  of  the  saliva,  a  patient,  dying  of  this  disease,  begged  that 
Desoenettes  would  take  a  part  of  what  was  left  of  the  draught  that 
had  been  prescribed  for  him.  AVithout  hesitation,  or  betraying  tho 
slightest  emotion,  Desgenettes  took  the  cup  from  the  sick  man,  filled 
it  up,  and  drank  its  contents  entire. 

If  we  believe  that  the  design  of  the  two  —  the  military  leader  and 
the  physician  —  was  the  same  at  this  time,  viz.,  to  infuse  confidence 
into  the  minds  of  the  soldiers,  it  is  not  difBcult  to  decide  to  which  of 
them  should  be  awarded  the  palm  for  this  daring  exposure  of  his  life. 
Napoleon  felt  that  all  his  prospects  of  conquest  and  fame  would  be 
clouded  unless  he  could  restore  the  sinking  courage  of  his  army  ;  and 
hence  he  readily  incurred  some  danger  to  secure  so  important  an  end. 
Desgenettes  was  buoyed  up  by  no  such  aspirations.  His  incentives 
were  humanity  and  a  search  after  truth.  AVhy  not  make  this  fine  trait 
of  the  physician  more  prominent  than  that  of  the  soldier  in  a  school 
history  ?  A  small  volume,  consisting  of  incidents  of  this  nature,  might 
be  prepared  and  introduced  into  the  public  schools.  I  would  offer  some 
additional  facts  and  reflections,  in  the  way  of  contributing  a  chapter  to, 
a  work  of  this  kind. 

While  French  medicine  was  thus  represented  in  Egypt  by  the  calrct 
and  self-  possessed  Desgenettes,  who  was  at  the  head  of  the  medical 
staff,  French  surgery  shone  with,  perhaps,  still  greater  lustre  in  the 
person  of  the  eminent  Lakkey,  who,  by  his  invention  of  the  light  am- 
bulance for  carrying  off  the  wounded  from  the  field  of  battle,  won  the 
affection  of  the  soldier,  and  by  this  act  alone  becomes  entitled  to  honor- 
able mention  in  the  annals  of  philanthropy.  From  the  burning  sands 
of  Egypt,  to  the  ice-bound  rivers  and  snow -covered  plains  of  Russia,, 
in  Poland,  in  Prussia,  in   Saxony,  in  Austria,   in  Italy,  in  Spain,  and  ir^ 


Bibliographical  Record.  277 

franco  itself,    Larkey  not  only  encountered  all  the  vicissitudes  of  climate 
and  season,   and  the  hardships  incident  to  camp -life,    but   he   was    con- 
stantly engaged  in  the  discharge  of  his  arduous  duties  as  field  and  hos- 
pital surgeon,  fearless  of  personal  risk,  and  intent  only  on  affording  the 
promptest  relief  to  those  placed  under  his  care.      He  did  not  wait  at  a 
'safe  distance  from  the  field  of  battle  for  the  wounded  to  be  brought  to 
him  ;  he  was  found  in  the  midst  of  the  wounded,  the    dying,    and   the 
d«ad,    ready   and   resolute,    and   always    self-possessed;    operating   with 
•equal  promptitude  and  skill  on   those  whom  he  could  first  reach  or  who 
'were  most   in  need  of  his  services,  and  not  caring  for  the  rank  of  the 
'prostrate  man  before  him.       Instances  are  recorded  in  which  Lakrey  and 
liis  assistants,  carried  away  by  their  professional,  and  shall  it  be  said,  in 
part,  also,  their  national  enthusiasm,  were  seen  giving  their  attentions  to 
the  wounded  near  the  imminent  and  deadly  breach  itself,  amidst  a  shower 
of  destructive  missiles  which  were   carrying  wounds  and  death  to  those 
uround  them.     Lauijey  was  exposed  to  the  same  fire  under  which  CaffeK' 
9ELLI,  Lannes,  Akkigiii,  Beauhaknais,  and  many  others,  fell,  either  wounded 
■or  never  to  rise  again.       After  the  long  -  contested  and  bloody  battle  of 
Eylau,  in  Polish  Prussia,  between  the  French  and  Russians,  the  Emperor 
Napoleon  found  Lakrey  standing  in  the  snow,  under  a  slight  canopy  of 
branches  of  trees,  engaged  in  dressing  the  wounded ;   and  on  his  passing 
by  the  same  place,  at  the  same  hour,  on  the  following  day,  he  saw  the  in- 
defatigable surgeon  still  occupied  as  before.     In  this  way  did  Larrey  spend 
twenty -four  hours  uninterruptedly,  except  in  the  few  minutes  snatched 
for  a  hurried  repast.       We  have  all  heard  or  read  of  displays  of  zeal — 
religious,  fanatical,  patriotic,  and   amorous  —  but  seldom  has  there  been 
recorded  a  finer  example  of  benevolent  zeal  spent  on  so  good  and  useful 
ft   purpose. 

The  Crimean  War,  too,  is  drawn  upon  for  illustrations 
t)f  Medical,  as  well  as  Military  Heroism,  and  the  diiference 
in  the  estimate  which  is  placed  upon  the  two  : 

We  change  the  scene,  and  this  time  it  opens  in  the  Crimea,  after  the 
battle  of  the  Alma,  in  which  the  Russians  were  defeated  by  the  allied 
troops  of  France  and  England,  in  1854.  You  have  read  of  the  feats  of 
valor  displayed  on  both  sides  on  that  bloody  field — the  sweeping  fire  of 
the  artillery,  the  daring  charge  of  cavalry,  the  deadly  encounter  of  the 
columns  of  infantry,  when  men  met  men  with  bayonets  crossed,  in  the 
mixed  excitement  of  animal  passion,  national  rivalry,  and  the  thirst  for 
honor  and  distinction.  The  names  of  St.  Arnaud  and  Raglan,  the  victo- 
rious Generals,  were  suddenly  sounded  and  sung  in  both  hemispheres,  and 
they  took  at  once  their  places  in  history.  But  the  real  hero,  the  saviour, 
not  the  destroyer,  appeared  on  the  day  after  the  battle,  unheralded  by 
drum  or  trumpet,  a  devoted,  and  to  all  appearances  a  doomed  volunteer  in 


2V8  The  Peninsular  and  Independent. 

the  cause  of  humanity.  The  allied  forces  were  under  the  military  ohliga- 
tion  of  advancing  rapidly  on  Sebastopol  in  pursuit  of  the  Tcticating  Rus- 
eians,  and  in  doing  so  to  leave  750  wounded  of  ihe  enemy  behind  them  on 
the  field  of  battle.  "  Who,"  to  use  tlie  words  of  an  English  medical  jour- 
nal, "is  that  single  individual  who,  of  all  the  host  that  is  murching  away 
from  the  scene  of  its  late  triumph,  is  still  to  be  found  on  that  blood-stained 
field?  And  what  is  the  errand  on  which  he  is  engaged,  thus  alone  among 
his  enemies,  watching  the  retreating  forms  of  his  friend<,  his  countrymen, 
and  gathering  up  his  courage  as  best  he  may,  to  undertake  the  duties 
which,  in  obedience  to  the  dictates  of  humanity,  it  had  become  his  duty 
to  perform  ?  This  most  painful  and  desolate  duty  was  imposed  on  himself 
by  Dr.  Thomson,  of  the  44th  regiment,  a  native  of  Cromart}^  in  the  noith- 
crn  part  of  Scotland,  the  birthplace  also  of  Hugh  Mii.leji,  of  the  Red  Sand- 
stone fame.  Provided  with  some  rum,  biscuit,  and  salt  meat,  he  was  left 
with  his  charge;  his  only  companion  a  private  soldier,  acting  as  his  ser- 
vant. This  was  indeed  a  forlorn  prospect.  Could  he  escape  from  tho 
savage  assaults  of  the  marauding  Cossacks,  a  party  of  whom  had  ruthlessly 
destro^'cd  a  villa  not  many  miles  off,  on  the  road  to  Balaklava,  tho 
residence,  too,  of  a  Russian  country  surgeon  or  physican,  who  had  been 
obliged  to  make  a  hasty  retreat?  Even  the  patient  themselves,  whether 
under  the  influence  of  fever,  caused  by  their  wounds,  or  by  mere 
brutal  ferocity,  had  fired  at  or  stabbed  the  humane  individuals  who 
were  then  dressing  their  wounds.  Five  days,  however,  did  Surgeon 
Thomson  pass  in  the  midst  of  such  a  people,  whose  language  was 
unknown  to  him,  without  any  companion  but  his  soldier -servant. 
Often  were  these  two  Englishmen  obliged  to  extricate  the  wounded 
from  beneath  the  dead  before  their  gashes  could  be  healed,  and  alsa 
to  bury  the  dead  because  of  the  pestilential  smell  arising  from  the 
mutilated  carcasses.  Their  scanty  supply  of  food  was  about  to  fail 
them.  On  the  dreaded  approach  of  a  swarm  of  Cossacks,  840  wounded 
men,  who  five  days  previously  lay  in  helpless  agony  on  the  ground^ 
walked  away  with  Surgeon  Thomson  to  the  shore,  and,  after  over- 
whelming their  deliverer  from  death  with  expressions  of  gratitude, 
sailed  for  Odessa.  The  surgeon  himself  escaped  from  the  Cossacks, 
and  reached  the  English  head-quarters  on  the  4th  of  October,  but  died 
of  cholera  the  next  day,  worn  out  by  the  hardships  he  had  under- 
gone. Surely,"  adds  the  English  journalist,  ''James  Thomson,  of  the 
4:4th  Regiment,  has  earned  a  monument,  for  in  his  own  noble  char- 
acter were  united  the  physician's  skill,  the  soldier's  courage,  and  the 
Christian's   humanity." 

The   heroism   and  philanthrophy  of  Pinel   is  thus   de-. 
scribed : 

Another   passage   for   the  records  of  lledical   Heroism,   and   I  have 
done: — 


JBihUograpliical  Record.  27D 

The  name  of  IIowakd  is  everywhere  celebrated,  and  praised  in 
terms  of  warm  gratitude,  as  the  reformer  of  prison  abuses  and  prison 
cruelties.  It  has  obtained  a  place  in  the  history  of  the  world's  pro- 
gress. The  name  of  Pinel  is  not,  I  am  afraid,  familiar  even  to  the 
medical  world;  and  it  is  still  less  to  the  world  at  large,  as  that  of 
a  ph3^sician,  who,  both  by  personal  services  and  earnest  teaching, 
brought  about  a  reform  in  the  management  and  discipline  of  Asylums 
for  the  Insane,  which  may  now  be  properly  regarded  one  of  the  strongest 
proofs  of  advanced  civilization.  If  a  proper  sympathy  and  sentiment 
for  humanity  and  justice  have  been  enlisted  by  the  benevolent  Eng- 
lishman, in  what  light  ought  we  to  regard  the  services  of  the  equally 
benevolent  Frenchman,  who  reminded  men  of  their  duties  to  the  Pro- 
vidence-stricken but  irresponsible  insane?  Excuse  might  be  found  for 
vindictive  harshness  to  the  criminal  who  has  made  war  on  society; 
but  where  is  the  extenuation  for  more  deliberate  cruelty,  practiced  so 
long  and  so  generally  on  those  unfortunate  beings,  barefc  of  their 
reason,  many  of  whom,  but  a  short  time  before,  had  been  the  delight 
of   the    social    circle,    and    cherished   members  of  the  family  ? 

When  we  think  of  the  old  Bedlams  and  Hospitals  for  the  Insane, 
in  which  not  only  the  raving  maniac,  but  the  melancholy  monomaniac 
was  confined,  and  in  which  the  only  sounds  were  those  of  the  clanging 
chain,  the  echoing  lash,  and  mingled  cries  and  vociferations  of  the 
brutal  keepers  and  the  mfariated  inmates;  and  then  look  abroad  over 
the  better  portions  of  the  civilized  world,  including  our  own  favored 
land,  and  see  the  many  noble  edifices  erected  for  the  reception  and 
treatment  of  this  class  of  unfortunate  fellow-beings,  we  feel  that  we 
live  in  an  age  not  only  of  progress,  but  of  real  improvement ;  one 
in  which  humanizing  influences  are  more  active  and  diffused  than  they 
ever  were  btifore.  The  cDntrast  between  the  present  and  the  past  in 
this  particular,  while  it  should  pr"o:iipt  all  to  tha  liveliest,  manifest- 
ations of  gratitude,  ought,  undoubtedly,  to  find  a  place  in  general 
history,  in  which  proper  credit  would  be  awarded  to  our  Profession, 
so  many  members  of  which  have  imitated,  in  their  official  position  as 
superintendents  of  Insane  Asylums,  the  noble  example  set  by  Pinel 
at  the   Bicetre   and   the   Salpetriere. 

That  was  indeed  a  critical  moment  in  the  life  of  Pinel,  and  in 
the  history  of  benevolent  trials  for  the  mitigition  of  human  suffering, 
when  he  resolved  to  test  the  correctness  of  his  principles  of  non-re- 
straint, by  holding  direct  personal  intercourse  with  a  violent  maniac, 
whose  chains  and  fetters  he  had  previously  directed  to  be  removed. 
The  trial  was  entirely  successful.  After  an  eager  gaze  and  a  move- 
ment, as  if  preparatory  to  a  tiger-like  spring  on  his  visitor,  who  had 
just  entered  his  cell,  the  unfortunate  being  saw  eyes  beaming  with 
kindness  and  placid  features,  expressing  benignity  and  good-will.  Soon 
his   own  countenance   underwent  a   change;  the  mere  brute  was   once 


280  The  Peninsular  and  Independent. 

again  a  human  being;  and  when  the  tones  of  affectionate  inquiry 
reached  his  car,  and  the  hand  of  greeting  was  extended  towards  him, 
he  could  only  answer  and  reciprocate  by  shedding  tears,  the  foun- 
tains of  which  had  long  been  dried  up  by  the  fiery  furnace  of  mad- 
dened feelings,  wrought  to  fury  by  angry  menace  and  brutal  punish- 
ment. From  this  moment  the  cure  of  the  poor  maniac,  which  had 
been  before  regarded  as  hopeless,  was  begun,  and  terminated  in  entire 
restoration   to   health   and   reason. 

After  the  inrpiiring  visitor  has  been  taken  through  a  modern 
lunatic  asylum,  and  traversed  its  spacious  corridors,  and  has  looked 
into  its  neat  and  cheerful  dormitories,  and  is  then  taken  to  the  saloon 
and  the  lecture  room,  and  the  rooms  for  social  meetings  and  amuse- 
ments, and  is  farther  shown,  out  of  doors,  the  extensive  grounds  for 
exercise  and  recreation,  all  under  the  direction  of  the  medical  super- 
intendent, the  presiding  genius  of  the  place,  he  gives  utterance  to  his 
conviction  by  exclaiming:  "After  all,  madness  is  not  so  dreadful  an 
infliction,  when  it  is  met,  controlled,  and  so  often  conquered  by  the 
harmonious  union  of  medical  science,  philanthropic  vigilance,  and  in- 
genuity, and,  at  fitting  times,  the  soothing  balm  of  religious  counsel 
and   exhortation. " 

In  the  vestibule  of  every  modern  lunatic  asylum,  the  visitor 
might  naturally  expect  to  see  a  statue  of  Pin  el,  unless  he  should 
think  at  the  moment  of  the  inscription  on  St.  Paul's  Cathedral,  Lon- 
don, in  allusion  to  its  celebrated  architect.  Sir  Christopder  When, 
"If  you  ask   for  a  monument,    look   around   you." 

Such  is  Medical  Heroism.  Such  are  some  of  the  bright 
examples  ^vhich  our  much  disparaged  Profession  furnishes. 
It  is  true  the  ^vorld  ignores  them,  and  that  Medical  Heroes 
are  not  appreciated  when  living,  and  are  forgotten  when 
dead.  But  he  who  patterns  after  them,  and  strives  to 
equal  them,  evinces  true  and  laudable  ambition  ;  for  it  is 
a  yearning  after  virtue  for  virtue's  sake. 

We  have  no  apology  to  offer  for  devoting  so  much  space 
to  the  notice  of  a  mere  pamphlet.  To  its  author,  Dr.  Bell, 
we  say:  Well  done;  a  worthy  subject  worthily  handled. 

G. 


Biblio graphical  Record.  281 

A  TREATISE  OxX  HUMAN  PHYSIOLOGY;  Designed  for  the  Use  of 
Students  and  Practitioners  of  Medicine.  By  John  C.  Dalton,  Jr., 
M.  D.,  Professor  of  Physiology  and  Microscopic  Anatomy  in  the 
College  of  Physicians  and  Surgeons,  New  York,  etc.  etc.  With  Two 
Hundred  and  Fifty -Four  Illustrations.  Philadelphia:  Blanchard  k 
Lea.     1859. 

There  are  two  classes  of  new  medical  works  which  we  greet 
w  ith  a  hearty  welcome :  they  are  Monographs,  and  Text- 
Books  for  the  use  of  students  which  have  not  been  subjected 
to  diluting  process.  The  book  whose  title  is  given  above 
belongs  to  the  latter  class.  It  is  not  as  extensive  a  work  as 
we  had  anticipated  ;  still  it  is  full  and  comprehensive  within 
its  scop-e.  In  the  latter,  it  has  been  the  object  of  the 
author  to  communicate,  "in  a  condensed  form,  such  new  facts 
and  ideas  in  physiology,  as  have  marked  the  progress  of  the 
science  within  a  recent  period." 

The  teacher  is  apparent  throughout.  Clear  and  concise  in 
his  statements,  the  reader  at  once  comprehends  his  meanings 
The  author  writes  jusfc  what  he  means,  and  means  just  what 
he  writes.  Words  are  not  used,  except  for  this  legitimate 
purpose,  viz..  To  express  an  idea.  Too  often,  with  authors, 
it  is  otherwise,  and  sentences  must  be  re-read,  scanned, 
compared  with  the  context,  and,  even  then,  if  the  author 
himself  ever  had  a  clear  idea  of  the  matter,  he  has,  by  the 
use  of  language,  so  successfully  hidden  it,  that  the  reader 
fails  to  obtain  it.  Dr.  Dalton  is  entirely  free  from  all  this  ; 
he  has  evidently  been  in  the  habit  of  talking^  to  convey  his 
true  meaning,  and  now  he  writes  in  the  same  style. 

The  typography  of  the  book  is  excellent.  The  illustra- 
tions are  beautifully  executed ;  and  of  the  two  hundred  and 
fifty -four,  all  but  eleven  are  original.  This  fact,  alone,  is 
enough  to  commend  the  book.  It  shows  that  the  enterprize 
is  not  one  originating  with  professed  book-makers.  It  is 
the  result  of  labor,  and  does  greai  credit  to  the  author. 

Let  us   have   more   real  authors,  and   let  the   horde   of 


282  The  Peninsular  and  Independent. 

qnaclving  editorial  parasites  betake  themselves  to  honest 
l.ibor;  so  shall  oiir  literature  and  our  national  credit  Lo 
alike  improved.  G. 

CLEVELAND  MEDICAL  GAZETTE.  A  Monthly  Journal  for  the  Ad- 
vancement and  Review  of  the  Medical  Sciences.  Edited  by  Gustav 
C.  E.  Webek,  M.  D.,  iVofcssor  of  Surgery  in  the  Cleveland  Medical 
College. 

No.  1,  Vol.  I.  of  this  new  journal  is  on  our  table.  Wo 
cordially  extend  the  hand  of  fellowship,  and  wish  the  editor 
all  the  success  he  desires.  It  has  been  placed  on  our  ex- 
oh  an  ire   list. 

o 

NORTH  AMERICAN  MEDICAL  REPORTER.      No.  2,  \'ol.  J  I. 

This  journal  has  changed  somewhat  in  appearance  since 
the  1st  No.  was  issued,  and  has  an  accession  to  its  Edito- 
rial corps  in  the  person  of  Louis  Elsburgh,  M.  D. 

ATe  are  under  obligations  to  the  courtesy  of  the  Editor 
for  giving  so  favorable  a  mention  of  the  Penxnsidar  and 
Independent. 


(Biiittixhl  §t^utmt\\t. 


»•  • 


Pharmaceutical  Education  of  Medical  Students. 

Pharmacy  is  making  rapid  strides  from  the  subordinate 
position  it  formerly  held  among  the  arts,  and  is  assuming  a 
high  position  in  its  double  relation  to  art  and  to  science, 
demanding  in  its  votary  mechanical  skill,  artistic  taste,  and, 
above  all,  chemical  knowledge.  While  its  progress  is  so 
rapid,  why  is  it  not  taught  in  all  of  our  medical  schools 
as  a  distinct  branch,  rather  than  as  an  adjunct  to  the 
Chair  of  Chemistry  ?  In  its  practical  relation  to  the  needs 
of  the  physician,  is  not  an  intimate  knowledge  of  the 
manipulatory  details  of  Pharmacy  of  infinitely  more  value 
to  him  than  a  sujoerficial  knowledge  of  chemical  laws,  theo- 
retically taught,  and  practically  almost  useless  ? 

An  intimate  investigation  of  the  physical  qualities,  as 
well  as  differences  and  kinds,  of  remedial  agents,  belongs 
to  a  pharmaceutical  education ;  and.  it  certainly  would  aid 
a  physician  in  determining  by  external  characteristics  alone 
the  quality  of  his  remedies. 

A  laboriously  acquired  skill  in  clothing  preparations 
with  attributes  of  permanence,  elegance,  concentration,  and 
efficiency,  is  a  part  of  the  Pharmaceutist's  requirements  — 
would  not  such  skill  aid  the  Physician,  especially  that  one 
who,  settled  in  the  more  thinly  scattered  portions  of  the 
country,  is  debarred  from  relying  upon  the  professional 
Pharmaceutist  ?     Apropos,  are  the  remarks  of  Dr.  Robert 


284  The  Peninsular  and  Independent. 

Battey,  of  Kome,  Georgia,  upon  this  subject,  tlie  pith  of 
which  are  given  below,  from  the  Southern  Medical  and 
Surgical  Journal: 

Pharmacy,  which  for  ages  occupied  the  position  of  a  mere  art, 
and  a  very  simple  one  at  that,  has,  daring  the  past  half  century, 
gradually  aroused  itself  from  this  long  sleep,  and  is  now  making 
giant  strides  towards  a  degree  of  perfection  little  dreamed  of  in  the 
phiiosnph}''  of  its  ancient  votaries.  Tlie  elixirs  and  amulets  of  our 
fathers  are  remembered  onl}'  with  a  complacent  smile  in  our  conscious 
superiority;  ignorance  and  superstition  have  given  place  to  the  light 
of  reason  and  inductive  philosoph}'.  A  co  mmendable  industry  and  zeal 
is  manifest  among  pharmaceutists  all  over  the  world,  vicing  with  each 
other  in  ransacking  the  nooks  and  corners  of  the  great  storehouse 
of  nature,  in  quest  of  hidden  treasures  to  be  added  to  the  rapidly 
augmenting  fund  of  the  Materia  Medica ;  while,  foremost  among  the 
evidences  of  progress  in  manipulative  pharmacy,  we  have  the  isolation 
of  the  distinct  active  proximate  principles  of  plants  from  the  inert 
and  valueless  ligneous  fibre,  and  the  substitution  of  small  doses  of 
these  refined  materials,  for  the  former  large  draughts  of  nauseous  in- 
fusions  and   decoctions. 

Not  only  has  Pharnlacy  thus  distinguished  herself  in  her  chemi- 
cal capacity,  but  she  been  equally  busy  in  the  improvement  of  her 
extemporaneous  and  more  mechanical  departments.  The  subtile  aeri- 
form spirit,  so  full  of  death  to  any  who  breathes  it,  has  been  chained 
down  in  its  watery  bed  by  strongest  bonds  of  iron,  whence  from 
time  to  time  it  issues  forth  under  the  guiding  hand  of  the  master, 
in  the  sparkling  and  healthful  mineral  water.  The  disgusting  epsom 
or  glauber  salt  no  longer  distorts  the  visage  of  the  invalid  —  but  he 
drinks  his  glass  of  effervescing  citrate  with  as  much  gusto  as  ho 
would  take  his  champagne  or  julep,  when  in  health;  his  castor  oil 
or  copaiba  glides  smoothly  along  his  alimentary  canal,  securely  stowed 
in  the  hold  of  a  tiny  gelatine  boat;  his  pill  no  longer  offends  the 
palate,  nor  sticks  fast  in  his  reluctant  throat,  but  with  its  firm  casing 
of  purest  sugar,  slips  swiftly  down;  and,  if  he  be  a  miser  at  heart, 
he  may  have  it  at  his  bidding,  clothed  in  all  the  charms  of  glitter- 
ing silver   or  still  more  precious  gold. 

The  spirit  of  the  age  is  progress  —  upward  and  onward  is  the 
watchword  we  catch  on  every  hand ;  in  perhaps  no  department  of 
natural  science  is  this  progressive  disposition  more  manifest  than  in 
the  one  under  consideration.     Scientific   Pharmacy  is  no  longer  a  mere 


Editorial  Department.  285 

abstraction  —  it  is  full  of  practical  results ;  nor  is  its  advancement  pre- 
mature —  the  people  have  kept  up  fully  with  the  times,  and  eagerly 
seize  and  appropriate  to  their  comfort  and  advantage  the  new  reme- 
dies as  fast  as  they  arc  brought  forward.  Its  products  are  not  to  be 
confined  to  the  more  refined  and  opulent  denizens  of  our  larger  cities, 
for  the  humble  settler  in  his  backwoodi  cabin  is  bsginning  to  hear 
the  sound  of  glad  tidings,  and  already  demands  that  the  more  palp- 
able impositions  upon  his  gustatory  nerve  shall  cease,  and  calls  for 
less  bulky  nauseous  remedies.  The  voice  of  the  masses  is  loud  in 
favor  of  the  reform,  and  the  old  fogy,  or  his  younger  pupil,  who 
refuses  to  inform  himself,  that  he  may  keep  up  with  the  improvQ' 
ments,  while  he  continues  to  laugh  at  the  disgust  and  wry  faces  of 
his  patrons,  will  find  his  moi'e  enterprising  and  worthy  competitors 
sweeping  by  him  in  their  onward  march  to  a  deserved  fame  and 
popularity. 

So  generally  is  the  want  of  pharmaceutical  knowledge  among 
physicians  felt  and  appreciated,  that  many  are  induced  to  seek  the 
schooling  of  the  apothecary's  shop  prior  to  entering  upon  the  study 
of  medicine;  while  others,  already  practitioners  of  Pharmacy,  are  led 
to  graduate  and  enter  the  medical  fraternity,  as  a  means  of  greater 
professional  elevation  and  emolument.  It  is  evident  that  very  few, 
comparatively,  of  our  medical  men  can  obtain  this  schooling  in  the 
shops,  requh'ing  as  it^  does,  a  series  of  3'^ears  before  an  apprentice  is 
judged  competent  to  execute*  the  more  responsible  manipulations. 
However  well  this  apprenticeship  system  may  work  in  England,  and 
however  desirable  so  thorough  pharmaceutical  attainments  may  be  to 
the  medical  man,  there  is  too  much  valuable  time  consumed  in  the 
pupilage   to   suit   the  fast  ideas   of  our  aspiring  young  men. 

The  office  of  the  preceptor  might  be,  and  ought  to  be,  a  valu- 
able preparatory  school  of  Pharmacy,  as  well  as  of  other  branches 
of  medical  science.  What  are  the  facts  ?  The  observation  is  common, 
that  the  medical  instructions  of  the  majority  of  preceptors  amount  to 
little  more  than  the  use  of  a  few  text-books  from  their  too  meagre 
libraries,  with  an  occasional  explanation,  and  a  rather  semi-occasional 
examination  upon  the  leading  topics  of  study.  Pharmacy  as  a  science, 
or  even  as  an  art,  is  very  rarely  mentioned,  and  seldom,  perhaps 
ne\>er^  taught;  and  if  we  ask  the  reason  of  this  we  shall  not  be^at 
a  loss  for  an  answer.  The  preceptor  himself  knows  little  or  nothing 
of  the  subject,  and  of  course  can  not  be  expected  to  teach  it  —  what 
little  he  has  acquired  has  been  the  result  of  hard  earned  experience; 
let   his   student   dig  it   out  as   lie  did. 

We  next  look  for  the  attainment  of  this  instruction  to  the  medical 
colleges   of  the   country,    and   with  what  better  success  ?    With,    I  be- 


2 so  The  Poiuisular  and  Independent. 

licvc,    but    one    honorable  exception    (the    University  of  Midiigin),    no 
distinct   Chair   of  Pharmacy  is    to  be   found.* 

In  most  instances  it  is  attached  cither  to  the  Chair  of  Chemistry 
or  Materia  Mcdica,  and  in  some  of  these  a  meagre  outline  of  tho 
subject  is  given,  while  the  majority,  perhaps,  retain  only  the  name, 
and  find  no  time  for  the  practical  instruction;  some  few,  it  is  be- 
lieved, do  it  not  the  honor  of  even  mentioning  its  name,  in  their 
annual  announcements.  In  some  of  the  larger  cities  this  deficiency  is 
in  a  measure  supplied  by  public  or  private  pharmaceutical  schools; 
but,  from  inabihty  or  indifference,  the  great  mnjorit}'  of  students  do 
not  avail  themselves  of  these  extra  privileges,  while  much  the  larger 
number  of  colleges  are  located  in  cities  where  these  private  schools 
are  not  accessible  and  can  not  be  maintained.  Besides,  it  is  unquestion- 
ably tlic  rUjlit  of  the  studoiit  to  look  to  the  regular  course  for  this 
indispensable  knowledge ;  as  well  might  the  school  refer  him  to  tho 
hospital  for  his  instruction  in  Surgery;  to  the  private  anatomical  room 
for  his  Anatomy;   or   to   the  private    laboratory   for   his   Chcmistr3^ 

In  our  college  courses  upon  Chemistry  much  valuable  time  is 
spent  ui)on  the  laws  of  heat,  light,  and  olectiicity  —  important  and 
interesting  topics  —  not  perhaps  too  fully  taught,  but  yet  it  may  well 
be  questioned,  whether  the  more  practical  details  of  Pharmac}'',  bearing, 
as  they  do,  upon  the  every  day  experience  and  wants  of  the  prac- 
titioner, arc  of  greatly  more  re(d  value.  It  is  ircU  to  have  the  ability 
to  discourse  learnedly  upon  the  laws  which  govern  the  imponderables, 
but  it  certainly  more  practical  to  be  able  to  dispense  an  eligible  and 
scientific  compound  for  the  relief  and  cure  of  one's  patient.  By  do- 
voting  one  half  or  more  of  time  usually  allotted  to  these  to  Pharmacy, 
much  valuable  instruction  could  be  given,  and  profession  thereby 
greatly  benefited.  The  Chemical  Chair,  however,  is  already  over- 
burdened ;  time  can  not  ordinarily  be  found  in  our  short  terms  to  so 
far  elucidate  the  various  topics  as  to  give  the  class  any  adequate 
knowledge  of  the  subject.  It  is  notorious  that  few  know  anything 
practically  of  the  science,  nor  do  they  pretend  to  any  degree  of 
proficienc3^  The  mass  of  the  candidates  single  out  this  branch  as  their 
lame    one,    and    more    than    all  else    usually    dread   the    ordeal   before 

"old "  (the  chemist)  in  the  green   room.    'The   subdivisions  of 

Organic  and  Physiological  Chemistry  are  daily  becoming  more  extended 
in  range  of  topics,  and  more  useful  and  important  in  results  —  it  is 
highly  desirable  that  the  standard  of  education  should  be  more  ele- 
vated  in   this   direction.     Look    now  to   the  Chair   of    Materia  Medica, 


*  We  mn«t  correct  the  above.  There  is  no  distinct  Chnir  of  rharmncy  in  the  Uai- 
vcvsity  of  Micliipaii,  it  1  oil  g  oltiiclicd  1o  tlie  riofcBsortliip  of  Chemistry,  etc.,  as 
is  usual  in  mcdlcul  scbools  iu  this  coautry. 


Editorial  Department.  2S7 

and  wc  find  medical  botany,  together  with  the  varieties,  physical  pro- 
perties, qualities  and  adulterations  of  drugs  so  inadequately  taught,  as 
to  leave  but  little  lasting  impression  upon  the  mind  of  the  hearer. 
The  whole  subject  is  exceedingly  dry  and  uninteresting  —  and  why? 
Not  always  from  want  of  ability  on  the  part  of  the  professor,  but 
rather  from  the  hurried  manner  in  which  the  subjects  must  be  dis- 
cussed, from  which  cause  the  student  gathers  an  insufficient  amount 
of  information  to  appreciate  and  enjoy  the  lecture;  so  he  must  often 
go  forth  into  the  world  dependent  npon  the  interested  drug  man  for 
the  selection  of  his  medicines,  and  perchance  to  mourn  over  the  dead 
bodies  of  his  victims  through  his  want  of  attention  to  the  stud}^  of 
these  subjects. 

The  only  efficient  mode  of  teaching  these  several  branches,  and 
giving  them  the  position,  which  their  practical  utility,  as  compared 
with  the  other  departments  of  medicine,  demands,  would  seem  to  bo 
the  addition  of  a  Chair  of  Pharmacy,  to  lighten  the  labors  of  the 
other  two,  as  well  as  to  tench  extemporaneous  and  manipulalivo 
Pharmacy  proper.  Such  an  innovation  upon  old  usage,  would  not  only 
lie  productive  of  much  good  to  the  Profession  in  elevating  the  edu- 
cational standard,  but  would  likewise  equip  our  medical  colleges  with 
all  the  facilities  and  advantages  of  a  well  regulated  college  of  Pharmacy, 
and  enable  them,  in  the  three  Chairs  alluded  to,  to  extend  facilities 
for  education  to  such  pharmaceutists,  and  their  clerks  and  apprentices, 
as  have  not  enjoyed  these  advantages,  in  places  "^here  no  regular 
organization  exists  for  their  benefit.  The  question  of  policy  might 
also  be  entertained  —  whether  or  not  diplomas,  or  certificates  of  pro- 
ficiency in  their  branch,  such  as  are  granted  by  the  Philadelphia 
College  of  Pharmacy,  should  be  bestowed  upon  these  pharmaceutical 
students  after  examination  at  the  close  of  a  second  course.  Next  to 
a  well  educated  medical  profession,  wc  need  intelligent  and  profession- 
ally accomplished  apothecaries ;  and  it  is,  perhaps,  worthy  of  thought, 
whether  the  general  adoption  of  this  system,  of  educating  apothecaries 
in  conjunction  with  students  of  medicine,  would  not  have  a  tendency 
to  infuse  a  more  high  minded  and  professional  spirit  into  the  former, 
and,  perhaps,  in  a  measure,  wean  them  off  from  their  quacking  pro* 
clivities,    by   attaching  them  more   strongly   to  our  Profession. 

That  the  study  of  Pharmacy,  in  its  practical  bearing?, 
will  be  added  to  the  curriculum  of  the  student  in  any 
of  our  numerous  medical  schools,  we  do  not  soon  expect ; 
but  that  it  is  desirable,  and  would  be  of  very  great  advantage 
to  them,  we  think  the  remarks  of  Dr.  Battey  suffieienlly 
prove.  r.  S. 


288  TJie  Peninsular  and  Independent. 

French  Pharmaceutical  rreparatlons. 

The  numerous  manifestations  of  skill  which  the  French, 
as  a  nation,  exhibit,  is  nowhere  more  clearly  exemplified  than 
in  the  products  emanating  from  the  laboratories  of  their 
Chemists  and  Pharmaceutists. 

The  rou(JEiiA  BiiOTHEUS,  of  New  York,  have  recently 
laid  on  our  table  samples  of  many  preparations,  with  which 
all  arc  fiimiliar  as  products  of  our  own  country,  but  which,  in 
the  forms  before  us,  bear  the  imprint  of  the  original  dis- 
coverers. 

Thus,  we  have  the  Iron  rtduccd  hij  llydrocjeUj  iji  QuE- 
VENNE  and  MiQUiLAiiD  (who  first  introduced  this  form  of 
Iron  into  therapeutical  use),  in  the  elegant  form  of  sugar- 
coated  drag6es. 

The  Pearls  of  Ether,  of  Cleutan,  in  which,  by  means 
of  a  gluten  capsule,  thin  and  transparent,  an  adequate  dose 
of  sulphuric  ether  is  enclosed,  and  in  such  a  manner  reaches 
the  stomach  before  its  peculiar  effects  are  obtained,  and 
without  beino:  lost  as  in  most  forms  in  which  it  is  exhibited. 

Lactate  of  Iron,  in  elegant  pas  tiles,  pleasantly  flavored, 
as  made  by  Gelis  and  Conte,  who  first  introduced  this 
advantao'eous  form  of  Iron. 

o 

The  Ergotine  of  Bon  jean — in  substance  and  dragees. 
This  extract  from  Ergot,  introduced  by  M.  Bonjean,  is 
made  by  exhausting  Ergot  with  water,  precipitating  with 
alcohol,  and  evaj^orating  to  the  consistency  of  a  soft  extract. 
It  is  held  in  high  estimation  in  France. 

Boudault's  Pepsin,  in  substance  and  in  powders,  all 
ready  divided.  This  "  aid  to  digestion"  is  coming  largely 
into  use  as  a  therapeutical  agent. 

Laurent's  Dragees  of  Acetic  Extract  of  Colchicums, 
form  an  excellent  bon-bon,  in  which  to  exhibit  this  remedy. 

Blancliard's  Preparation  of  Iodide  of  Iron,  in  pills  and 
syrup,  are  too  well  known  in  this  country  to  require  com- 
ment. 


Editorial  Department.  289 

We  must  particularly  mention  tlie  Copaliine  Mege  of 
JozEAU,  and  the  Savonules  of  Lebel^  in  both  of  which 
copaiba  is  very  nicely  disguised — not  only  disguised,  but, 
in  the  first,  by  boiling  the  copaiba  with  a  small  proportion 
of  nitric  acid,  oxidizing  it ;  and  in  the  second,  by  saponifi- 
cation, the  balsam  is  rendered  much  more  active,  digests 
readily,  and,  to  a  great  extent,  produces  its  specific  local 
action. 

A  hundred  other  remedies,  in  elegant  forms,  are  before 
us  ;  many  of  which,  however,  have  only  a  local  reputation, 
but  all  bear  the  impress  of  skill  and  taste. 

A  French  pharmaceutist,  in  making  any  discovery,  sub- 
mits it  to  the  Academy  of  Medicine  of  Paris.  If  it  obtains 
the  approval  of  that  body,  the  method  of  making  it  is 
published,  but  the  right  of  manufacture  is  reserved  by 
governmental  protection  to  the  discoverer.  Thus,  it  will  be 
seen,  that  the  French  scientific  pharmaceutist  has  the  hope 
of  pecuniary  reward  as  well  as  scientific  reputation,  as  an 
incentive  to  research.  F.  S. 


voL.n.~T. 


tUtlti  ^rlitUs,  ^hstxutis,  &t. 


On  the  Physiological  Position  of  Fibrin 

By   Lbvih  S.   Jotnes,   M.  D., 
ProfoMor  of  Initiiutes  of  Medicine  in  the  Medical  College  of  Virginia. 


(Concluded  from  the  July  No.) 

Let  us  now  sec  what  arc  the  principal  facts  and  arguments  by  which 
this  view  is  supported,  and  endeavor  to  appreciate  their  value: 

1.  It  is  urged  that  the  proportion  of  fibrin  in  the  blood  is  too  small 
to  warrant  the  idea  that  it  is  the  sole,  or  even  the  chief  pabulum  of  the 
tissues.  It  amounts  to  but  two  or  three  parts  in  1,000  of  the  fluid,  while 
the  albumen  is  estimated  at  about  70,  and  the  red  corpuscles  at  125  to 
140  parts. 

2.  There  is  no  fibrin  in  the  egg  from  which  all  the  tissues  of  the 
young  bird  are  developed — "little  or  none"  in  the  blood  of  the  foetus 
—  and  less  in  the  new-born  child  than  the  adult;  although  at  these 
periods  of  existence  nutrition  and  development  arc  proceeding  with  greater 
activity  than  in  after  life. 

3.  "I  find,"  says  Mr.  Simon  (?<>(•.  cit.),  "that  fibrin  is  undiminished 
by  bleeding,  however  frequently  repeated ;  nay,  that  it  often,  or  even 
usuall}''  increases  under  this  debilitating  treatment:  its  highest  figure 
given  in  Andral's  book  (10-2),  was  at  a  fourth  bleeding:  and  Scherer 
found  it  as  high  as  12-7  at  the  third  venesection  in  a  case  of  pneumonia. 
I  find  that  under  man}^  other  circumstances  of  exhaustion  and  weakness 
and  inanition,  during  the  progress  of  starvation,  during  diseases  essentially 
anasmic,  during  violent  fatigue,  and  the  like,  its  proportion  has  been  found 
at  least  as  high,  perhaps  higher  than  in  the  inflammatory  process."  In 
these  respects  its  proceeding  is  in  direct  contrast  to  that  of  the  red  cor- 
puscles. Andkal  and  Gavarret  have  also  found  an  improvement  of  the 
breed  of  an  animal  is  attended  with  a  diminution  of  the  fibrin  of  its 
blood,  but  with  an  increase  of  its  red  corpuscles. 

4.  Fibrin,  it  is  said,  does  not  arise  from  the  ingestion  of  food,  for 
its  proportion  in  the  blood  is  not  increased  by  the  most  abundant  nutri- 


Selected  Articles^  Abstracts^  (Jbc.  291 

Incnt,  and  there  is  less  in  the  blood  of  the  carniverous  animals  than  in  that 
of  the  herbivora. 

5.  Its  composition  shows  that  it  is  an  oxidized  product — that  it 
results  from  the  oxidation  of  albumen  (or  of  some  kindred  principle  of 
the  tissues) ;  and  in  the  animal  economy,  oxidation  pertains  rather  to 
disintegration  and  waste  than  to  the  repair  of  tissue.  It  marks  the 
descending  scale  of  metamorphosis  rather  than  the  ascending  —  a  ten- 
dency to  destruction  rather  than  a  tendency  to  organization.  Thus 
urea,  uric  acid,  and  other  ingredients  of  the  excretions  are  oxidized  pro- 
ducts. Experiment  proves  conclusively  that  the  respiration  of  pure 
oxygen  causes  an  increase  of  the  fibrin  of  the  blood. 

6.  Although  the  majority  of  chemists  have  agreed  in  stating  that 
there  is  a  somewhat  higher  average  proportion  of  fibrin  in  arterial 
than  in  venous  blood,  it  is  now  said  that  Lehmann  had  recently  found, 
that  while  this  is  true  so  far  as  regards  a  comparison  of  the  blood  of  the 
large  veins  with  that  of  the  arteries,  -the  blood  of  the  smaller  veins 
-contains  moi'e  fibrin  than  arterial  blood,  as  if  it  had  just  derived  a  fresh 
"charge  from  the  disentegration  of  the  tissues.  {Broion-Sequard^s  Jour, 
de  Physique,  April,  1858). 

7.  The  proportion  of  fibrin  in  the  blood  is  always  increased  in  in- 
flammatory affections,  where  the  acceleration  of  the  capillary  circulation 
and  the  attendant  emaciation  indicate  an  increased  waste  of  tissue.  As 
the  excitement  of  the  circulation  subsides,  and  nutrition  resumes  its 
healthy  course,  so  does  the  fibrin  return  to  its  normal  standard. 

8.  Experiments  on  the  transfusion  of  blood  prove  that  fibrin  is  not 
^essential  to  nutrition.  If  an  animal  be  bled  to  complete  syncope,  and 
its  own  blood  or  that  of  another  animal  of  the  same  species  be  injected 
into  its  veins  (being  first  wholly  deprived  of  its  fibrin  by  stirring  it  with 
-a  bundle  of  twigs  while  still  fluid),  the  animal  nevertheless  seems  to 
^'  acquire  fresh  life  at  every  stroke  of  the  piston,"  and  is  after  a 
"time  completely  restored.  The  red  corp)uscles  are  evidently  the  efficient 
agents  in  the  resuscitation;  for  if  the  serum  of  the  blood  only  be  in- 
jected, the  animal  is  not  revived. 

In  like  manner,  Brown -Sequard  has  found,  that  if  the  amputated 
limb  of  a  man  or  animal  be  allowed  to  lie  for  several  hours,  until  its  vital 
properties  (muscular  irritability  and  impressibility  of  the  nerves  to 
timuli)  have  disappeared,  they  may  be  promptly  restored  and  maintained 
for  hours  by  the  injection  of  defihrinated  blood  into  the  vessels.  And, 
what  is  very  singular,  it  is  stated  by  the  experimenter,  that  although 
the  blood  be  injected  without  its  fibrin,  and  arterial  in  hue  (from  expo- 
sure to  the  air),  it  returns  by  the  veins,  presenting  the  appearance  of 
venous  Mood  and  containing  fibrin  —  whence  he  infers  that  fibrin  is 
formed  in  the  tissues,  especially  in  the  muscles,  as  a  product  of  their 
■their  waste  or  vital  decay.     This  conclusion  is  also  adopted  by  Bernard 


292  The  Peninsular  and  Independent. 

in  his  late  work,   ^■'■LeQons  sur  les  Proprietes  Physiologiques.  et  Us  Alte- 
rations Fathologiqves  des  Liquides  de  V  Organism e.'^''     Paris,  1859. 

Experiments  similar  to  the  above  were  performed  upon  decapitated 
criminals,  and  with  corresponding  results. 

9.  The  blood  of  the  hepatic  veins  contains  no  filrin.  (Lehmann, 
Brown- Sequard,  Bernard.)  The  same  is  also  true  of  the  renal  xein, 
(Franz  Simon,  Bernard,  Brown -Sequard.)  Fibrin,  therefore,  disappears 
from  the  blood  which  traverses  these  glands ;  it  undergoes  destruction 
there.  Brown -Sequard  has  endeavored  to  prove  by  a  mathematical  cal- 
culation, in  his  journal  above  cited,  that  this  destruction  amounts  to  some 
four  or  five  killogrammes  (10  or  12  pounds)  daily,  while  its  normal  pro- 
portion in  the  blood  is  kept  up  by  the  waste  of  the  tissues. 

10.  Effusions  of  fibrin,  it  is  argued,  either  exhibit  no  tendency  at 
all  to  undergo  organization,  or  their  organization  is  of  the  lowest  charac- 
ter, "never  in  any  known  instance,"  says  Dr.  Handfield  Jones,  "amount- 
ing to  more  than  the  formation  of  a  fibrous  tissue,  more  or  less  closely 
resembling  the  natural."  "That  fibrin  takes  an  important  part  in  the 
reparative  process,  can  not  be  doubted.  We  constantly  find  it  forming  the 
uniting  medium  between  divided  parts;  but  have  we  any  evidence  that 
it  becomes  further  developed,  and  passes  into  the  form  of  any  tissue 
more  highly  organized  than  that  of  the  cicatrix?  Surely  there  is  not  the 
least;  or  rather,  all  that  we  know  of  the  process  of  reparation  tends  to 
contradict  such  an  idea."  (Jones  and  Siecel:ing''s  Pathological  Anatomy^ 
p.  59).  Mr.  Simon  (op.  cit.  j).  82)  is  still  more  decided:  "So  far  as  my 
knowledge  extends  of  adhesive  inflammation,  and  of  the  several  repa- 
rative processes,  I  see  no  evidence  that  fibrin  takes  a  more  important 
part  in  them,  than  that  of  holding  the  true  albuminous  blastema  within 
its  meshes,  and  thus  occasionally  serving  as  a  provisional  matrix  and 
scaffolding  for  the  development  of  cells,  fibres,  and  blood  vessels."  He 
also  refers  to  the  absence  of  organization  in  the  fibrinous  clots  lining  an 
aneurismal  sac,  in  the  coagula  which  forms  in  arteries  after  ligature,  and 
in  the  fibrinous  concretions  often  seen  in  the  substance  of  the  liver, 
spleen,  and  kidneys,  as  proof  that  fibrin  is  destitute  of  that  high 
plasticity^  or  tendency  to  organization,  which  has  been  ascribed  to  it^ 

Such  is  the  formidable  array  of  arguments  that  we  have  to  consider. 
That  they  make  out,  at  first  sight,  a  very  strong  case,  can  not  be  denied. 
Some  of  the  facts  adduced  seem  to  be  in  complete  opposition  to  the 
ideas  heretofore  entertained.  A  deliberate  and  candid  survey  of  the 
whole  ground,  however,  will  suffice  to  convince  an  unprejudiced  mind,  I 
think,  that  these  arguments  are  wholly  insufficient  to  prove,  either  that 
fibrin  is  an  excretory  compound,  resulting  fi-om  the  destructive  changes 
going  on  in  the  tissues  or  in  the  blood,  or  that  its  function  in  the  nutri- 
tion and  repair  of  tissue  is  of  the  very  lowest  order.  "We  are  still  fully 
justified  in  adhering  to  the  belief  that  fibrin  is  a  highly  important  "  ele- 


Selected  Articles^  Abstracts^  <&g.  293 

tnent  of  nutrition,"  specially  and  eminently  organizable,  though  we 
have  no  sufiBcient  reason  for  asserting  that  it  is  the  only  histogenetic 
principle  of  the  blood,  and  that  albumen  was  must  pass  through  the 
condition  of  fibrin  in  order  to  be  applied  to  the  wasting  tissues. 

1  will  examine  the  above  arguments  in  the  order  in  which  they  have 
been  presented. 

If  the  quantity  of  fibrin  in  the  blood  be  small,  compared  with  that 
of  the  albumen  or  red  corpuscles,  how  large  is  it,  on  the  other  hand, 
when  compared  with  that  of  the  organic  matters  admitted  by  all  to  be 
effete  and  useless  —  for  example,  urea,  uric  acid,  creatine,  &c.  In  order 
to  detect  these  in  the  blood,  we  are  obliged  to  analyze  several  pounds  of 
the  fluid  —  nature  guarding  the  system  with  the  utmost  jealousy  against 
the  accumulation  of  compounds  which  are,  at  best,  but  useless  refuse, 
and  would  soon  become  noxious,  if  allowed  to  taint  the  blood  in  notable 
quantity.  The  amount  of  fibrin,  on  the  contrary,  is  such  as  to  impart 
to  the  blood  some  of  its  most  remarkable  properties,  and  sufficient,  too, 
one  would  think,  to  make  good  its  claim  to  a  function  of  importance. 

Besides,  although  the  amount  of  fibrin  in  the  circulating  fluid  at  any 
one  moment  be  small  —  not  more  than  five  drachms,  it  is  estimated  —  it 
Ttnust  be  recollected  that  it  is  leing  continually  produced  in  the  organism, 
as  it  is  being  continually  disposed  of  in  the  operations  of  life;  and  thus, 
beyond  question,  a  large  amount  is  daily  generated  and  expended.  Fi- 
brin is  being  constantly  introduced  into  the  blood  as  an  ingredient  of 
the  chyle  and  Ij^mph,  and  as  incessantly  formed  in  the  blood  itself — in 
all  probability,  by  the  transformation  of  albumen. 

There  is  no  fibrin,  it  is  said,  in  the  egg^  which  contains  all  the 
organic  matters  which  are  requisite  for  a  perfect  animal  development. 
True  —  but  the  material  from  which  fibrin  may  be  elaborated  (albumen), 
is  there  in  abundance;  and  this  elaboration  does  take  place  at  an  early 
period  of  development;  for  when  the  blood  makes  its  appearance,  fibrin 
too  appears  as  one  of  its  constituents. 

I  am  not  acquainted  with  any  well-authenticated  analysis  which 
justifies  Mr.  Simon's  assertion  that  there  is  "little  or  no"  fibrin  in  the 
blood  of  the/b^ws.  There  is  somewhat  less,  it  is  true,  than  in  the  blood 
of  the  adult.  The  analysis  of  Denis,  which  is  quoted  in  all  the  works 
on  physiology,  gives  for  the  mother's  blood,  2-4  of  fibrin,  and  for  that  of 
the  foetus,  2-2  in  1,000  parts  of  the  fluid.  The  difference  is  certainly 
not  great  enough  to  serve  as  the  basis  of  an  argument  on  the  question 
at  issue,  and  is  no  greater  than  often  exists  in  the  blood  of  different 
healthy  adults.  The  same  remark  may  be  made  with  reference  to  the 
comparative  deficiency  of  fibrin  in  infancy.  And  it  may  be  asked  whe- 
ther the  smaller  proportion  of  this  principle  at  these  early  stages  of 
'existence,  may  not  be  owing  to  its  more  rapid  consumption  for  the  pur- 
poses of  development  and  nutritition? 


294  The  Peninsular  and  Independent. 

The  great  and  striking  peculiarity  of  foetal  blood,  is  its  high  proper-. 
tion  of  red  globules  and  iron. 

That  the  abstraction  of  blood  in  inflammatory  diseases  does  not  di- 
rectly reduce  the  proportion  of  fibrin,  can  not  appear  surprising,  when 
we  recollect  that  a  cause  is  in  operation,  tending  directly  to  its  increase  ;■ 
and  it  can  not  be  expected  to  diminish  until  the  inflammation  begins  to. 
subside.  Even  in  health,  however,  bleeding  has  no  tendency  to  reduce  the- 
proportion  of  fibrin,  but  (if  often  repeated)  rather  the  reverse,  as  certain, 
remarkable  experiments  of  Magendi  have  shown.  It  appears,  therefore,^ 
that  the  system  enjoys  the  power  of  rapidly  repairing  the  loss  of  its 
fibrin,  by  the  conversion  of  the  albumen  of  the  blood ;  and  when  excited' 
by  unusual  demands,  this  physiological  action  may  become  excessive. 

As  to  the  increase  of  fibrin  in  starving  animals^  which  at  first  view 
seems  so  paradoxical,  we  find  a  very  satisfactory  explanation  in  the  ob- 
servations of  Andral  and  Gavarket,  who  found  this  condition  of  the 
blood  in  animals  deprived  of  food,  to  coincide  with  lesions  of  the  sto- 
mach "  of  the  most  clearly  inflammatory  nature,  such  as  bright  redness,^ 
softening,  and  numerous  ulcerations  of  the  mucous  membrane," 

So  in  phthisis  —  the  excess  of  fibrin  which  is  common  in  the  bloo^ 
after  the  first  stage,  is  not  to  be  referred  to  the  anaemic  or  cachectic 
condition  of  the  system,  but  to  the  inflammatory  irritation  of  the 
lungs  and  pleura,  which  attend  the  softening  and  evacuation  of  the  tuber-, 
cles.  The  mere  tubercular  deieloj^ment  is  not  attended  with  any  such 
alteration  of  the  blood.  Andral's  researches,  in  like  manner,  establish^ 
that  in  the  blood  of  persons  affected  with  cancer,  there  is  no  increase  of^ 
fibrin,  sometimes  on  the  contrary  a  diminution,  unless  there  be  accom-. 
panying  inflammation  of  some  kind. 

It  ought  not  to   seem   so   unaccountable  that  the  fibrin  is  undimi- 
nished in  anaemia  —  for  no  good  reason  can  be  given  why  the  loss  of  red' 
corpuscles  should  be  attended  with  a  corresponding  loss  of  fibrin.     The 
several  ingredients  of  the  blood  may  vary  in  proportion  quite  indepen- 
dently of  each  other. 

The  alleged  diminution  of  the  fibrin  in  the  blood  of  animals,  simul-. 
taneously  with  an  "improvement  of  breed,"  is  a  circumstance  of  rather 
too  vague  and  indefinite  a  character  to  merit  much  consideration.  It  i&. 
not  pretended,  I  believe,  that  the  difference  thus  occasioned  is  any- 
greater  than  may  normally  exist  between  two  individuals  of  any  one 
breed  —  nor  is  it  proved  that  the  nutritive  process  is  nK)re  perfectly  ac- 
complished  in  proportion  to  the  loss  of  fibrin.  Differences  of  breed  ir^ 
animals  relate  to  other  and  more  prominent  characters  than  this. 

There  is  no  sufficient  reason  for  saying  that  the  fibrin  of  the  blood 
does  not  derive  its  source  fi-om  the  food,  or  that  its  amount  is  not  affected 
by  the  nature  of  the  food.  True,  the  blood  of  the  carnivora  contains.- 
less  than  that  of  the  herbivora;   but  this  is  connected  with  differences. 


Selected  Articles^  Abstracts^  <&c.  295 

of  organization  and  vital  action  in  the  two  orders,  which  forbid  us  to 
refer  to  them  as  true  standards  of  comparison  for  each  other.  In  any- 
one animal,  or  in  different  individuals  of  one  species,  the  proportion  of 
fibrin  is  higher  under  an  animal  than  under  a  vegetable  diet.  This  is 
proved  by  Lehmann's  experiments  upon  himself,  and  by  those  of  Nasse 
upon  dogs.     Fibrin  itself,   when  employed  as  food,  is  certainly  nutritious 

—  capable  of  furnishing  plastic  material  to  the  blood.  In  making  this 
statement,  I  am  not  alluding  to  muscular  flesh,  which,  according  to  the 
chemists  is  not  fibrin:  I  speak  of  the  fibrin  of  the  blood.  The  "gelatin 
committee  "  of  Paris  found  that  dogs  fed  on  this  fibrin  alone,  lived  from 
75  to  80  days,  while  on  a  diet  of  pure  gelatin,  they  died  in  about  20 
days.  It  is  true  that  the  fibrin  did  not  sustain  life  continuously,  but  it 
proved  no  worse  in  this  respect  than  albumen  or  muscular  fibre  (if  de- 
prived of  the  matters  associated  vvith  it  by  long  boiling.  Dogs  lived  no 
longer  on  these  than  on  the  fibrin  of  blood.  The  simple  fact  is,  that  no 
one  proximate  principle,  whether  animal  or  vegetable,  is  capable  of 
nourishing  the  animal  body  perfectly  and  for  a  length  of  time :  but  we 
have  the  same  experimental  proof  that  fibrin  can  do  its  part  in  alimen- 
tation, that  we  have  in  the  case  of  albumen  or  the  muscular  substance. 
(See  BerarWs  Cours  de  Fhys.  vol.  1,  p.  591).  But  fibrin,  when  in- 
jested,  does  not  all  find  its  way  as  Jibrin  to  the  blood:  for  in  the 
process  of  .gastric  digestion,  it  is  transformed  into  that  modification 
of  albumen  called  albuminose  or  peptone,  in  order  that  it  may  be  the 
more  readily  absorbed.  Once  within  the  absorbent  vessels,  part  of  it 
reverts  to  the  condition  of  fibrin,  in  order  to  meet  the  demand  of  the 
organism  for  this  principle.  So  when  the  albumen  of  the  egg  or  the 
casein  of  milk  is  employed  as  food,  a  part  after  absorption,  is  converted 
into  fibrin,  as  shown  by  the  coagulability  of  the  chyle. 

The  excess  of  oxygen  which  the  ultimate  analysis  of  fibrin  exhibits 
as  compared  with  that  of  albumen  and  other  protein  compounds,  and 
which  is  relied  upon  to  prove  that  the  former  is  an  "oxidized  product" 

—  a  protein  compound  in  the  first  stage  of  "destructive  metamorphosis" 
or  decay,  and  therefore  to  be  placed  in  the  same  category  as  urea,  &c., 

—  is  very  inconsiderable,  if  indeed  it  exists  at  all.  Can  it  be  admitted 
(in  view  of  what  has  already  been  stated)  that  the  differences  between 
these  compounds  are  such  as  to  require  us  to  assign  to  them  different 
physiological  relations  ?  Can  it  be  for  a  moment  supposed  that  two 
principles  so  slightly  differing  from  each  other  in  composition  and  other 
chemical  characters  as  albumen  and  fibrin,  should  ho^NQ  precisely  oppo- 
site destinations',  the  former  to  nourish  and  repair  the  most  highly  vi- 
talized textures  —  the  other  to  encumber  the  circulation  as  so  much  offai 
until  it  finds  an  outlet  in  a  still  more  degraded  form  by  the  channels  of 
excretion?  Certainly  such  a  supposition  does  great  violence  to  proba- 
bility. 


296  The  Peninsular  and  Independent. 

Ledmann,  with  reference  to  the  relation  of  these  hodic.",  remarks 
{Manual  of  C hem.  Fhys.  p.  110):  It  must  be  conceded,  from  the  whole 
occurence  of  fibrin,  that  it  is  a  product  of  the  transformation  of  albu- 
men." "7/*  ice  could  rely  wpon  the  elementary  analysis  of  these  sub- 
stances, the  small  excess  of  oxygen  which  is  found  in  fihrin  might  char- 
acterize it  as  a  product  of  oxidation.''^  But  he  none  the  less  admits 
"the  physiological  importance  of  fibrin,  as  a  transitionary  state  towards 
the  more  highly  oxidized  tissue  materials"  :  for  in  another  place  he  points 
out  the  fact  that  the  tissues  "  are  on  the  average  much  richer  in  oxygen 
than  thejn^otein  hodies^  Whence  it  follows,  that  the  action  of  oxygen 
upon  the  latter  is  far  from  being  necessarily  a  destructive  or  retrograde 
action,  as  has  been  rather  too  hastily  supposed,  under  the  influence  of 
preconceived  ideas. 

The  statement  made  by  Brown -Sequard,  on  the  authority  of  recent 
researches  of  Leiimann,  that  the  blood  of  the  small  veins  contains  more 
fibrin  than  that  of  the  arteries,  is  certainly  worthy  of  attention:  and  if 
the  fact  could  be  accepted  as  undeniable,  it  would  certainly  afford  a  very 
plausible  ground  for  presuming  that  the  excess  of  fibrin  in  the  small 
veins  had  been  derived  from  the  tissues,  as  a  product  of  their  waste.  We 
may  take  leave,  however,  to  hold  the  fact  sith  judice,  until  it  shall  bo 
confirmed  b}''  the  analysis  of  other  observers  and  shown  to  be  generally 
(and  not  merely  exceptionally)  true.  It  must  be  confessed  that  the  fact 
is  completely  at  variance  with  the  general  result  of  previous  researches, 
which  had  revealed  an  average  preponderance  of  fibrin  in  arterial 
blood. 

The  invariable  augmentation  of  fibrin  in  the  blood  of  inflammation, 
is  a  fact  full  of  interest  in  a  physiological  aspect,  but  very  difficult  of 
consistent  explanation,  whatever  be  our  view  of  the  character  and  des- 
tination of  this  substance.  If  we  regard  it  as  a  product  of  the  disinte- 
gration of  the  bodily  structures,  we  maj"  reasonably  ask,  how  it  is  that 
in  grave  typhoid  fever^  where  the  wasting  and  exhaustion  are  certainly 
much  greater  than  in  sthenic  inflammations,  there  is  a  loss  of  fibrin 
instead  of  an  increase  ?  Whereas,  on  the  hypothesis  in  question,  the  pro- 
portion ought  to  be  higher  than  in  the  phlegmasias.  If  we  regard  fibrin 
as  a  product  of  oxidation,  why  should  it  be  constantly  increased,  and 
often  to  a  very  high  figure,  in  inflammations  of  the  respiratory  organs, 
however  severe  or  extensive  —  though  these  must  necessarily  interfere 
with  the  supply  of  oxygen  to  the  blood  ?  If,  on  the  other  hand,  we  re- 
gard fibrin  as  a  nutritive  or  histogenetic  principle,  shall  we  say  that 
the  blood  in  inflammation  contains  more  of  it  because  the  demand  for 
it  on  the  part  of  the  tissues  is  less  active,  and  therefore  more  remains 
unused?  We  should  then  have  to  encounter  the  difficulty,  that  the 
fibrin  undergoes  increase  in  starvation,  where  there  is  certainly  no  lack 
of  demand  for  whatever  nutriment  the  tissues  may  obtain. 


Selected  Articles^  Abstracts^  dbc,  '     297 

In  a  word,  the  true  cause  of  the  fibrinous  character  of  inflammatory 
blood  is  a  problem  yet  to  be  solved — and  at  present  the  fact  can  afford 
no  valid  support  to  any  physiological  hypothesis. 

The  results  of  the  transfusion  of  defibrinated  blood  in  living  animals, 
and  the  highly  interesting  experiments  of  Brown -Sequard  upon  its 
injection  into  decapitated  bodies,  and  amputated  limbs,  do  not,  I  appre- 
hend, justify  the  inference  that  has  been  drawn  from  them.  They  do 
not_  prove  that  fibrin  has  no  office  in  the  blood  as  a  source  of  nutri- 
ment to  the  tissues.  As  well  might  we  argue  from  them  that  albumen 
is  equally  to  be  excluded  from  the  category  of  nutritive  principles ;  for 
when  an  animal  is  bled  to  the  point  of  death,  the  injection  of  the  serum 
of  blood  (which  contains  all  the  albumen)  will  not  effect  resuscitation. 
The  red  corpuscles  are  the  potential  agents  in  the  restoration  of  the 
vital  properties  of  the  nerves  and  muscles,  not  because  they  alone  take 
part  in  the  nutrition  of  these  tissues,  but  because  they  are  carriers  of 
oxygen^  and  the  presence  of  oxygen  is  necessarry  to  the  manifestation 
of  the  properties  in  question.  There  are  satisfactory  reasons  for  believing 
that  every  development  of  nerve  force,  and  every  muscular  contraction,  is 
attended  with  (and  necessitates)  a  clw.nge  in  the  active  tissue  —  a  disinte- 
gration of  part  of  its  substance  —  in  which  the  oxygen  of  the  blood  takes 
an  essential  part.  It  is  for  tins  reason  that  the  presence  of  the  red  corpus- 
cles is  necessary  for  the  restoration  of  nervous  and  muscular  irritability; 
but  there  is  a  wide  difference  between  this  action  and  the  supply  of  solid 
material  to  the  tissues  for  the  repair  of  waste.  The  experiments  are 
entirely  consistent  with  the  supposition  that  the  fibrin  and  the  albumen 
both  take  part  in  this  office. 

The  fact  stated  by  Bkown- Sequard,  that  the  blood,  though  bright 
red  when  injected,  had  the  appearance  of  venous  blood  when  it  returned 
by  the   veins,  is  perfectly  in  accordance  with  the  explanation  just  given. 

The  presence  of  fibrin  in  the  blood,  after  traversing  the  limb,  though 
it  contained  none  when  injected,  by  no  means  compels  the  admission 
that  this  fibrin  was  derived  from  the  tissues,  as  the  experimenter  sup- 
poses. It  was  simply  an  example  of  the  transformation  of  albumen  into 
fibrin,  such  as  is  continually  going  on  in  the  circulation  during  life. 
Robin  and  Vekdeil  expressly  take  this  view  of  it.  A  similar  formation 
of  a  small  quantity  of  fibrin  in  blood  which  has  been  deprived  of  it,  is 
occasionally  seen  when  the  blood  is  allowed  to  stand  in  an  open  vessel. 
However,  the  amount  of  fibrin  which  appeared  in  the  blood  in  the  ex- 
periments above  cited,  is  admitted  by  the  author  himself,  to  have  been 
^^exti'Smement  minlme.'''' 

The  alleged  absence  of  fibrin  in  the  venous  blood  returning  from 
the  liver  and  the  kidneys,  has  been  regarded  a  vcrj  significant  and  con- 
clusive fact.  If,  indeed,  fibrin  undergoes  destruction  in  those  glands, 
and   the  products  of  its  composition  are  eliminated  by  them,  we  must 


298  The  Peninsular  and  Independent. 

abandon  all  opposition  to  the  hypothesis  which  regards  fibrin  as  merely 
a  part  of  the  refuse  of  the  system,  circulating  for  a  time  in  the  blood 
only  that  it  may  find  an  outlet  through  the  organs  of  excretion.  But 
I  attach  little  value  to  all  that  has  been  said  on  this  subject,  for  more 
than  one  reason.  In  the  first  place  I  do  not  think  it  is  proved  that 
fibrin  is  normally  and  constantly  absent  from  the  blood  of  either  of  the 
above  mentioned  veins.  As  to  the  hepatic  veins,  the  statement,  though 
very  confidently  made  by  the  authors  already  cited,  is  directly  negatived 
by  the  results  obtained  by  Fkanz  Simon,  and  recorded  in  his  "  Chemis- 
try of  Man,"  p.  174.  In  two  instances  (the  only  ones  in  which  he  ex- 
amined this  blood)  he  found  it  to  contain  2  0  and  2*5  parts  of  fibrin  — 
the  proportion  of  the  same  element  in  the  blood  of  the  portal  vein  of 
the  same  animals,  being,  in  the  first  case  3  2;   in  the  second,  3-5. 

Buown-Sequahd  also  admits 'that  he  has  three  times  observed  co- 
agula  (though  of  no  great  size)  to  form  in  blood  drawn  from  the  hepatic 
veins  —  and  further,  that  after  death  the  blood  contained  in  these  vessels 
is  ordinarily  found  "coagulated  or  coagulable"  —  to  explain  which,  he 
thinks  it  necessary  to  suppose  a  reflux  of  blood  (of  course  containing 
fibrin)  from  the  vena  cava.  Admitting  it  to  be  true  that  the  venous 
blood  from  the  liver  contains  less  fibrin  than  that  of  other  parts  of  the 
vascular  system,  and  sometimes  none  that  we  can  detect,  it  must  be 
borne  in  mind  that  the  reduction  has  already  commenced  in  the  jjortal 
circulation^  .and  should  not  be  set  down  wholly  to  the  action  of  the  liver ; 
for  all  observers  agree  that  the  portal  blood  is  poor  in  fibrin. 

As  it  respects  the  blood  of  the  renal  vein,  too.  Brown -Seqcaud 
admits  that  after  death  it  is  usually  found  to  be  coagulable  or  com- 
pletely coagulated ;  which  must  of  course  be  due  to  the  presence  of 
fibrin.  He  further  states,  that  when  this  vein  is  opened  in  a  living  ani- 
mal, although  the  blood  which  at  first  flows  gives  no  indication  of  the 
presence  of  fibrin,  yet  if  it  be  allowed  to  flow  for  three  or  four  minutes, 
some  fibrin  makes  its  appearance,  and  after  seven  or  eight  minutes  it  is 
present  "in  notable  quantity."  Bernard  makes,  on  this  subject,  the 
following  singular  remark :  "  The  blood  of  the  renal  vein  coagulates^ 
though  it  contains  no  fthnny  I  leave  it  to  chemists  to  decide  whether 
the  first  branch  of  the  proposition  does  not   invalidate  the  last. 

Having  thus  shown  with  what  large  allowance  we  must  receive  the 
assertion  that  the  fibrin  disappears  from  the  blood  which  traverses  the 
liver  and  the  kidney,  I  next  inquire  what  has  become  of  this  lost  fibrin  ? 
—  for  we  must  at  least  admit,  I  suppose,  a  diminution  oi  it.  It  has 
not  been  excreted  by  those  glands  —  for  neither  the  bile  nor  the  urine 
contains  a  trace  of  this  principle:  nor  do  they  contain  any  ingredient 
which  can  by  any  reasonable  presumption  be  ascribed  to  its  decomposi- 
tion. There  is  no  more  reason  for  assuming  any  such  destructive  change, 
than  for  supposing  that  the  fibrin  is  consumed  in  nourishing  the  organs 


Selected  Articles^  Abstracts^  <&c.  299 

in  question,  or  (more  probably)  that  it  undergoes  some  unknown  change 
of  condition,  attended  with  the  loss  of  the  characteristic  property  of 
coagulation,  by  which  it  is  usually  recognized.  Perhaps  it  may  revert 
to  the  condition  of  albumen.  F.  Simon's  comparative  analysis  of  the 
blood  of  the  renal  vein,  and  the  arterial  blood  of  the  same  animal, 
renders  this  a  very  plausible  supposition;  for  he  found  that  while  the 
blood  of  the  vein  had  lost  the  greater  part  of  its  fibrin  {not  al\  as  he 
is  made  by  some  writers  to  say),  it  had  gained,  albumen  in  about  equal 
amount.  According  to  the  same  chemist,  the  blood  of  the  hepatic  veins 
also,  while  containing  less  fibrin  than  that  of  the  portal  vein,  contains 
a  decidedly  larger  proportion  of  the   albumen. 

The  idea  promulgated  by  Bernard,  in  his  Lectures  on  the  Blood, 
that  the  fibrin  is  consumed  in  the  liver  in  the  production  of  the  sugar 
which  he  has  proved  to  make  its  appearance  in  that  organ,  is  purely 
hypothetical,  and  rests  on  no  valid  foundation. 

The  properties  exhibited  by  fibrin  in  inflammatory  exudations,  and 
the  phenomena  of  the  repair  of  injuries,  so  far  from  affording  any  ar- 
gument against  the  doctrine  that  fibrin  is  a  plastic  material  of  the 
most  essential  importance,  furnishes  the  most  conclusive  proof  in  its 
favor. 

The  assertion  that  the  fibrinous  coagula  lining  an  aneurismal  sac  — 
those  forming  the  so-called  "polypi  of  the  heart" — and  concretions  of 
the  same  kind  in  the  midst  of  the  parenchymatous  structures,  are  inca- 
pable of  organization,  is  entirely  at  variance  with  the  positive  testimony 
of  some  of  the  highest  authorities  in  pathology.  I  take  it  to  be  also  an 
established  fjict,  that  a  coagiilum  of  bloody  whether  in  the  cavity  of  an 
artery  that  has  been  tied,  or  in  the  substance  of  the  brain,  or  elsewhere, 
may  be  organized  and  vascularized,  though  with  comparative  tardiness — 
the  presence  of  the  red  corpuscles  in  the  midst  of  the  fibrin  seeming  to 
delay  the  occurrence  of  the  vital  changes. 

But,  not  to  dwell  on  these  points,  I  refer  next  to  the  all -important 
fact,  that  in  all  inflammatory  effusions  which  manifest  a  capacity  for  or- 
ganization, and  in  the  exudations  which  serve  as  the  medium  for  the  re- 
paration of  wounds  and  fractures^  fibrin  is  an  invariable  ingredient^  and 
its  presence  is  absolutely  indispensable  to  the  occurrence  of  those  organic 
changes  which  result  in  the  development  of  new  tissue.  Here,  as  else- 
where, fibrin  exhibits  its  property  of  spontaneous  coagulation,  which,  be 
it  remarked,  is  always  the  first  step  in  the  organizing  process.  The 
term  coagulaMe  lympli^  so  constantly  applied  to  these  plastic  exudations, 
has  familiarized  our  minds  to  the  fact. 

It  is  true  that  this  "lymph"  (which  consists  essentially  of  the 
•* plasma"  of  the  blood,  or  liquor  sanguinis^  exuded  from  the  vessels, 
contains  other  solid  ingredients  besides  fibrin.  A  considerable  propor- 
tion of  albumen  is  there  with  some  fatty  matter,  and  various  salts,  es- 


300  The  Peninsular  and  Independent. 

pecially  phosphates.  Sometimes,  too,  a  few  red  corpuscles  of  the  blood 
are  present,  either  entire,  or  in  a  disintegrated  state.  But  though  an 
exudation  contain  all  tlie  other  ingredients,  if  no  fibrin  be  present,  not 
the  slightest  tendency  to  organization  is  ever  manifested.  Thus,  serous 
eflfusions  into  the  pleura  or  peritoneum,  which  contain  every  element 
that  coagulable  lymph  does,  except  fibrin,  never  give  rise  to  the  forma- 
tion of  false  membranes :  nor  is  there  any  instance  of  a  mere  serous 
exudation  serving  for  the  reparation  of  an  injured  tissue.  A  true 
^''blastema''''  is  always  more  or  less  rich  in  fibrin.  This,  in  the  exercise 
of  its  distinctive  property,  first  concretes  upon  the  parts  from  which  it 
was  effused:  then,  by  the  agency  of  nucleated  cells,  or  nuclei,  which 
make  their  appearance  in  the  blastema,  fibres  are  formed ;  and  finally, 
by  the  extension  of  vessels  into  it  from  the  adjacent  living  parts,  the 
organization  of  the  new  tissue  may  be  said  to  be  virtually  completed. 

It  deserves  to  be  particular!}'-  remarked,  too,  that  the  degree  of  plas- 
ticity of  the  exudation  depends  much  on  the  qnal'itu  of  the  fibrin  — 
and  this,  in  its  turn,  is  intimately  connected  with  the  condition  of  the 
organism  at  large,  and  of  the  blood  in  particular.  When  there  is  suflB- 
cicnt  vigor  of  constitution,  and  the  blood,  besides  a  due  proportion  of 
^  other  ingredients,  is  rich  in  fibrin,  and  this  fibrin  exhibits  in  a  perfect 
degree  its  property  of  coagulation,  then  the  exudation  enters  readily  upon 
the  career  of  development.  But  in  unhealthy  states  of  the  system,  when 
the  fibrin  of  the  blood,  however  abundant,  is  defective  in  qualit}'',  the 
exudations  into  which  it  may  happen  to  enter,  arc  (to  use  the  language 
of  Dr.  AViLLiAMs)  cither  "  cacoplastic"  or  "aplastic"  —  that  is  to  say, 
either  not  at  all  organizable,  or  exhibiting  this  property  in  a  very  low 
degree. 

I  know  it  has  been  urged  that  effusions  which  contain  fibrin,  may 
nevertheless  be  without  any  tendency  to  organization.  Thus,  in  some 
cases  of  drops}',  the  fluid  is  fibrinous,  as  is  proved  by  its  spontaneous 
coagulation  when  exposed  to  the  air ;  and  yet  no  false  membranes  are 
formed  from  such  effusions.  This,  however,  may  be  ascribed  either  to 
the  small  amount  of  fibrin  in  the  fluid,  or  to  the  presence  of  some  cause 
interfering  with  the  exercise  of  its  peculiar  endowments.  The  fact 
nevertheless  remains,  and  can  not  be  denied  or  evaded,  that  the  presence 
of  a  due  proportion  of  fibrin  is  the  indispensable  condition  of  an  organ- 
izable exudation. 

It  is  argued,  however,  that  the  organization  of  a  fibrinous  blastema 
is  always  of  a  very  low  grade,  resulting  in  the  development  of  nothing 
higher  or  more  complex  than  a  simple  fibrous  tissue.  "This,  almost  of 
itself,"  remarks  Dr.  Handfield  Jones,  "is  a  proof  that  fibrin  is  not 
the  peculiarly  organizable  or  plastic  element  that  it  has  been  considered 
to  be." 

This   must    certainly   be  regarded   as  a  rather   extraordinary  state- 


Selected  Articles^  Abstracts^  (&c.  301 

ment.  It  is  true,  indeed,  that  the  coagulable  lymph  effused  either  on 
inflamed  serous  membranes,  or  between  the  lips  of  a  wound,  always 
at  first  forms  by  its  organization  a  fibrous  or  areolar  tissue.  But  docs 
the  process  necessarily  stop  there  ?  By  no  means.  The  ultimate  destina- 
tion of  the  new  structure  depends  much  upon  the  nature  of  the  adja- 
cent living  parts.  "All  lymph,"  says  Mr.  Paget,  "has  some  tendency 
to  assume,  sooner  or  later,  the  characters  of  the  tissue  in  or  near  which 
it  is  seated,  or  in  place  of  which  it  is  formed."  And  thus  there  may 
be  developed  from  a  plastic  exudation,  not  only  the  above  named  simple 
tissue,  but  blood  vessels,  elastic  tissue,  mucous  membrane,  serous  mem^ 
brane,  skin,  cartilage,  bone,  adipose  tissue,  lymphatic  vessels,  even  ner- 
vous tissue:  for  divided  nerves  may  heal,  and  re -acquire  their  functions 
perfectly  in  the  course  of  a  few  weeks  —  and  we  have  good  authority 
for  saying  that  nerve  fibres  have  been  more  than  once  seen  in  inflam- 
matory adhesions. 

Now,  what  warrant  is  there  for  excluding  fibrin  from  any  partici- 
pation in  these  ulterior  developments  of  the  blastema  ?  Why  regard  it 
as  useless,  and  albumen,  the  fatty  principles,  &c,,  alone  efficient,  when 
we  know  that  in  the  outset,  they,  in  the  absence  of  fibrin,  are  wholly 
destitute  of  the  least  capacity  for  organization?  Would  it  not  be  more 
consistent  to  say  that  the  principle  which  takes  the  first  stejj,  also  takes 
an  important  part  throughout?  Such  is  surely  the  prima  facie  conclu- 
sion, and  I  know  of  nothing  which  invalidates  it.  I  am  acquainted  with 
no  fact  relating  to  the  organization  of  new  formations  which  gives  any 
real  countenance  to  Mr.  Simon's  opinion,  that  the  fibrin  of  the  blastema 
affords  merely  a  "scaffolding"  or  mechanical  support  for  the  other  ele- 
ments, and  takes  no  part  itself  in  the  development  of  cells  and  fibres, 
and  in  the  various  subsequent  changes.  What  single  reason  is  there  to 
show  that  albumen  takes  the  leading  part  in  all  these  phenomena?  If 
any  should  lay  stress  on  the  fact  that  fibrin  is  inadequate  to  the  perfect 
repair  of  the  muscular  tissue  when  wounded,  it  maj'-  be  answered  that 
it  is  not  more  inefficient  than  other  animal  principles  in  this  particular 
—  the  fact  being  that  losses  of  the  muscular  tissue  are  never  repaired 
by  a  new  production  of  the  same  kind  of  tissue. 

We  have  every  reason  to  infer  that  the  same  materials  w^hich  are 
employed  in  the  regeneration  of  the  tissues,  are  also  those  which  are 
applied  to  the  repair  of  their  daily  waste :  for  it  is  admitted  that  the 
two  processes  are  but  modifications  of  one  and  the  same  function  of 
nutrition.  If  fibrin  is  an  essential  means  of  tissue  formation  in  the  one 
case,  it  must  equally  be  so  in  the  other.  It  is  not  easy  to  see  how  the 
justice  of  this  conclusion  can  be   disputed. 

Dr.  Carpenter  has  advocated  an  opinion  on  this  subject  in  the 
later  editions  of  his  works,  which  is,  to  say  the  least,  paradoxical ;  viz. 
that  fibrin  is  applied  to  the  nutrition  of  the   "  fibro  -  gelatinous  tissues " 


302  The  Peninsular  and  Index)cndent, 

(fibrous,  areolar,  &c.),  but  takes  no  part  in  that  of  the  higher  structures. 
He  maintains  on  the  one  hand,  that  fibrin  is  a  vitalized  principle,  as 
proved  by  its  possessing  '*the  power  of  spontaneously  passing  (under 
certain  conditions)  into  an  organized  tissue";  but  on  the  other,  that  is 
"the  special  pabulum  of  those  connective  tissues,  whose  physical  offices 
in  the  economy  are  so  important,  while  their  vital  endowments  are  so  lowy 
He  thus  assigns  the  only  proximate  principle  which  he  regards  as  truly 
vitalized,  to  the  nutrition  of  some  of  the  least  vitalized  structures.  There 
is  surely  here  a  glaring  inconsistency. 

Dr.  Cakpentek's  idea  seems  to  have  been  suggested  by  the  fact,  that 
fibrin,  in  undergoing  spontaneous  coagulation,  assumes  a  more  or  less 
distinct  filamentous  arrangement,  which  reminds  one  of  the  structure  of 
the  white  fibrous  tissue.  But  he  seems  to  have  forgotten  that  a  coa- 
gulum  of  fibrin,  however  perfectly  "fibrillated,"  is  not  fibrous  tissue. 
The  production  of  this  on  the  surface  of  an  inflamed  membrane  or  a 
wounded  part,  is  a  subsequent  affair,  being  effected  by  the  development 
of  nucleated  cells,  which  then,  by  particular  changes  of  form,  undergo 
transformation  into  true  fibres.  It  would  be  remembered  too,  that  fibrous 
tissue  consists  not  of  fibrin,  but  of  gelatin. 

On  the  whole,  there  does  not  appear  to  be  any  satisfactory  reason 
for  limiting  the  histogenetic  uses  of  fibrin  to  the  fibrous  and  areolar 
structures.  Its  peculiar  "vital"  endowments,  which  distinguish  it  so 
remarkably  fiom  other  organic  compounds,  would  rather  claim  for  it  a 
higher  destination. 

The  principal  arguments  in  favor  of  the  hypotheses  which  I  have 
been  combatting,  have  now  been  reviewed,  and  found  (if  I  mistake  not) 
wholly  inconclusive.  Some  of  them  would  invite  a  more  extended  dis- 
cussion, but  T  must  hasten  to  a  close.  I  can  not  conclude,  however, 
without  calling  attention  to  a  few  other  points  in  the  history  of  fibrin, 
which  appear  to  bear  strongly  on  its  physiological  relations. 

1.  Fibrin  is  a  constituent  of  the  chyle.  Evident  indications  of  it 
are  found  in  the  fluid  drawn  from  lacteals  of  an  animal  in  full  digestion, 
at  their  very  issue  from  the  intestine;  but  its  quantity  progressively 
increases  by  the  transformation  of  albumen,  and  its  characters  become 
more  perfectly  developed  as  the  chyle  moves  along  the  vessels  towards 
the  thoracic  duct,  and  through  it  into  the  venous  system ;  and  a  further 
increase  takes  place  as  the  blood  passes  from  the  venous  to  the  arterial 
side  of  the  circulation.  We  may  affirm,  therefore,  that  the  2'>roportlon  of 
fibrin  increases  as  the  j)roducts  of  digestion  a^jproach  the  ])oints  where 
materials  are  needed  for  the  nutrition  of  tissue :  and,  we  may  ask,  if 
fibrin  be  an  excrementitious  product,  why  should  it  appear  in  the  chyle 
directly  after  its  absorption?  We  can  not  account  for  its  presence  here 
by  the  waste  of  tissue,  nor  can  we  reasonably  suppose  the  occurrence  of 
a  "retrograde  metamorphosis" — a  destructive  change  in  the  products  of 
digestion  as  soon  as  they  are  absorbed. 


Selected  Articles^  Abstracts^  <$:c.  303 

2.  Fibrin  is  normally  found  only  in  the  nutritive  fluids  of  the  eco- 
nomy—  the  blood,  chyle,  and  lymph.  It  is  not  a  constituent  of  any 
excretion  —  as  are  all  those  ingredients  of  the  blood  which  are  admitted  to 
be  excrementitious  —  such  as  carbonic  acid,  urea,  uric  acid,  creatine,  &c. 

3.  Fibrin  is  nature's  agent  for  the  arrest  of  licemorrhage.  When 
vessels  are  divided,  the  coagulation  of  the  blood  is  the  means  by  which 
occlusion  is  mainly  effected,  and  the  flow  permanently  arrested.  If  the 
blood  contained  no  fibrin,  and  were  therefore  not  coagulable,  hemorrhage, 
even  from  the  slightest  wound,  could  never  be  arrested  by  the  efforts 
of  nature.  But  for  the  same  protective  property,  every  separation  of  a 
gangrenous  part  would  be  attended  with  bleeding.  Effusions  of  fibrin 
is  also  the  means  by  which  suppuration  is  circumscribed,  and  prevented 
from  assuming  that  diffuse  character  which  is  sometimes  so  destructive. 
In  these  several  particulars  fibrin  performs  offices  which  are  signally  con- 
servative.  Can  we  say  as  much  for  any  of  those  products  of  wear  and 
tear  which  constitute  the  true  offal  of  the  system  ? 

It  has  been  aptly  remarked  that  the  organism  hears  an  inc7'ease  of 
Jibrin  better  than  a  diminution.  Witness  the  comparative  gravity  of 
sthenic  inflammation,  and  the  severer  grades  of  typhoid  fever.  Not  so 
with  any  organic  compound  of  the  excrementitious  class.  The  accumu- 
lation of  these  in  the  blood  is  the  signal  of  urgent  peril. 

4.  Is  it  mere  fancy  that  sees  in  the  spontaneous  coagulation  of  fibrin, 
and  the  definite  disposition  which  its  particles  usually  assume  in  soli- 
difying, the  indication  of  a  special  tendency  to  organization  ?  And  is 
it  unwarrantable  to  argue  therefrom,  the  possession  by  this  principle  of 
a  certain  degree  of  vitality?  I  know  the  chemico-phj^siological  school 
of  the  present  day  repudiate  in  toto  this  ancient  doctrine  of  Hunter. 
They  see  in  fibrin  a  mere  chemical  compound  like  albumen  or  gelatin — - 
not  more  animalized  than  they — and  regard  its  coagulation  as  a  mere 
physical  consolidation,  really  peculiar  only  in  the  conditions  under  which 
it  takes  place.  But  as  these  same  philosophers  reject  altogether  the  in- 
tervention of  vital  forces  in  the  operations  of  life,  regarding  the  living 
organism  as  swayed  wholly  by  the  same  physical  and  chemical  laws 
which  control  dead  matter,  it  is  not  from  them  that  we  are  to  expect  an 
impartial  answer,  when  any  question  of  vitality  arises.  But  if  we 
recognize  such  a  thing  as  vitality  at  all  —  if  we  regard  organization  as 
the  invariable  index  and  accompaniment  of  life  —  if  we  admit  vitality  in 
the  egg,  because  under  certain  external  conditions  it  becomes  developed 
into  a  complex  organized  being  —  we  must  equally  allow  that  a  fibrinous 
effusion  upon  a  living  surface  is  vitalized :  for,  although  external  to  the 
vessels  which  circulate  the  blood,  and  withdrawn  from  the  sphere  of 
action  of  the  nerve  force,  it  becomes,  by  virtue  of  its  own  inherent 
properties,  the  seat  of  a  process  of  organization,  which  results  in  the 
development  of  living  tissues,  more  or   less   perfectly  resembling  those 


304  Tlie  Peninsular  and  Independent. 

of  which  the  organism  was  originally  constituted :  and  as  the  plastic 
power  which  determines  all  these  remarkable  imitations  of  natural  devel- 
opment pertains  especially  to  fibrin,  the  presence  of  which  is  their 
iine  qua  non^  the  recognition  of  vitality  in  it  is  not  only  allowable,  but 
unavoidable.  Its  passage  from  a  fluid  state  to  that  of  a  definitely  arrang- 
ed coagulum,  is   the  first  manifestation  of  that  vitality. 

All  attempts  to  ascribe  this  coagulation  to  the  operation  of  mere 
chemical  or  physical  influences,  have  failed.  It  is  a  change  which  fibrin 
always  undergoes  of  its  own  accord,  when  it  is  not  kept  moving  in 
contact  with  liviiaj  jmrtH,  whatever  be  the  external  conditions  in  other 
respects.  When,  in  the  course  of  the  circulation,  the  plasma  of  tho 
blood  is  effused  from  the  capillaries  into  the  midst  of  the  tissues  for 
their  nutrition,  the  fibrin,  being  now  at  rest^  is  free  to  pass  to  the  solid 
state,  and  enter  into  combination  with  the  tissue  or  tissues  of  which  it 
is  the  appointed  food. 

What  those  tissues  are,  we  can  not  in  the  present  state  of  the 
science  declare.  If  we  can  not  atfirm  positively  that  the  muscular  is 
one  of  them  (or  the  only  one),  on  the  other  hand,  the  differences  be- 
tween fibrin  and  the  substance  of  muscle  are  not  so  great  as  to  au- 
thorize us  positively  to  deny  it.  It  was  with  no  hope  of  solving  this 
problem  that  I  undertook  the  investigation  of  this  subject.  AVhat 
I  have  attempted  to  prove  is,  first,  that  fibrin  is  not  a  product  of  vital 
decay,  but  a  principle  destined  for  the  nutrition  of  tissue ;  secondly, 
that  its  agency  in  this  respect  is  not  restricted  to  the  tissues  of  the 
lowest  grade.  Further  than  this  we  can  not  go,  without  venturing  into 
the  domains  of  speculation.  ^Vc  have  no  just  ground  for  affirming 
that  fibrin  is  the  only  immediate  tissue -forming  ingredient  of  the  blood 
—  that  the  albumen  (for  example)  which  abounds  there,  must  pass 
through  the  form  of  fibrin  before  combining  with  any  living  structure; 
the  probabilities  are  all  against  such  an  exclusive  view.  But  that  fibrin 
is  a  specially  and  eminently  organizalle  or  histogenetic  material  —  this 
I  am  convinced,  is  a  truth  which  can  not  be  successfully  controverted. 
To  this  extent,  at  least,  I  am  still  content  ''■stare  super  antiquas  r/a*." 


ABSTRACTS  AND  SELECTIONS  for  the  PEMXSULAR  A\D  L\DEPEM)Ex\T. 


By  M.  A.  Patterson,  M.  D.,  Tecumseh. 


ADHESIVE  PLASTER  IN    MAINTAINING  COUNTER  -  EXTENSION  IN    THE 
TREATMENT  OF  OBLIQUE  FRACTURES  OF  THE  LOWER  EXTREMITY. 

In  the  report  of  surgical  practice  in  the  Pennsylvania  Hospital, 
continued  in  the  April  30th  No.  of  the  Med.  and  Surgical  Reporter,  it  is 
stated  that  Dr.  Neill,  the  surgeon  on  service,  spoke  as  follows:     "If  there 


Selected  Articles^  Abstracts^  <&c.  305 

is  anything  that  the  hospital  is  calculated  to  teach  it  is  the  proper  treat- 
ment of  fractures."  Fractures  may  be  as  well  managed  in  that  hospital 
as  in  similar  institutions,  but  if  we  except  the  adoption  of  adhesive  bands 
for  maintaining  extension,  a  method  by  no  means  novel,  no  material 
change  has  been  made  during  the  last  forty  years  in  their  apparatus  for 
dressing  oblique  fractures  of  the  thigh  bone. 

A  similar  apparatus,  modified  by  Dr.  Buck,  has  been  used  in  the  New 
York  Hospital  for  more  than  twenty  years,  in  which  the  Desault  and  Phy- 
sick  splint  was  originally  introduced  as  a  substitute  for  the  double -inclined 
plane. 

The  Burge's  plan  is  regarded  by  some  intelligent  surgeons  as  a 
decided  improvement ;  approaching  the  ideal  of  Desault  nearer  than  any 
previous  method,  "  by  making  the  tuberosity  of  the  ischium  the  point 
cV  a'pui^''  and  obviating  undue  pressure  upon  the  groin.  It  is  also  urged 
in  favor  of  tlie  Burge's  splint  that  the  patient  may  assume  a  sitting 
posture,  at  his  pleasure,  during  the  process  of  his  cure.  But  Dr.  Lente, 
a  surgeon  of  no  small  experience  in  this  department  of  practice,  remarks : 

The  fact  seems  to  be  that  neither  the  groin  nor  the  tiiberosity  is  fitted 
to  hear  alone  the  presHiive  of  the  counter-extension  in  cases  of  considerable 
shortening,  and  tlierefore  of  great  tension  in  the  application  of  the  ex- 
tending power.  It  is  therefore  my  object,  in  the  further  modification  of 
the  New  York  Hospital  apparatus,  to  distribute  the  pressure  on  these  two 
points. 

Dr.  Lente's  proposed  modifications  are  ingenious,  and  may  answer  a 
valuable  purpose;  but,  if  Dr.  Gilbeut's  views  are  correct,  the  mere  modi- 
fication of  the  splint  is  not  an  object  of  the  first  importance.  The  trouble 
usually  arises  from  the  friction,  and  long  continued  pressure  of  the  un- 
adherent  counter- extending  bands  upon  a  comparatively  small  extent  of 
surface,  whether  that  surface  be  over  the  tuberosity  of  the  ischium  or 
the  perineum. 

Until  within  a  few  years  it  was  found  exceedingly  diflScult,  in  very 
many  cases,  to  sustain  the  requisite  extension,  without  injury  to  the  tissues 
underlying  the  ordinary  extension  bands ;  now  the  use  of  adhesive  plaster, 
with  the  attachment  of  Lente's  wooden  block  at  the  extremity  of  the 
loop,  to  prevent  undue  pressure  upon  the  malleoli,  seems  to  be  all  that 
is  desired,  so  far  as  extension  is  concerned. 

If,  then,  adhesive  plaster  has  been  found  so  useful  in  maintaining  ex- 
tension, why  will  it  not  answer  equally  as  well  for  counter -extension? 
For  the  practical  solution  of  this  question,  as  intimated  in  the  last  No.  of 
this  Journal,  we  are  indebted  to  Dr.  Gilbert,  who  has  communicated  the 
results  of  his  experience  on  this  subject  in  a  paper  read  before  the  Col- 
lege of  Physicians  of  Philadelphia.  From  this  paper,  as  published  in  the 
American  Journal  of  the  Medical  Sciences^  we  quote  as  follows: 

The  adhesive  plaster  counter-extending  bands  become  firmly  adherent 
to  a  large   extent  of  integument,  consequently  there  can  be  no  friction 

Vol.  II.  — u. 


306  The  Peninsular  and  Independent, 

upon  its  surface;  and  through  this  extensive  union  with  the  skin  pressure 
is  widely  and  evenly  diffaf^ed.  In  the  use  of  anv  of  the  ordinary  unattach- 
ed, counter-extending  means,  the  extent  of  suifacc  occn[)ied  at  the  seat  of 
pressure  does  not  ex<^eed  eight  square  inches  ;  a  fractional  part  only  of 
which  sustains  its  greatest  intensit}',  viz.,  th;it  which  overlies  the  tuher 
ischii,  the  edge  of  its  ascending  ramus,  and  a  narrow  space  of  the  body 
of  the  pubis.  The  extent  of  surface  to  which  the  adhesive  plaster  counter- 
extending  bands  are  attached,  on  the  other  hand,  amounts  to  about  one 
hundred  square  inches,  over  all  of  which  the  tension  and  pressure  arc 
equally  distiilnited.  \n  the  use  of  the  former,  all  the  tissues  lying  upon 
the  points  of  bone  mentioned,  endure  constant  pressuie,  amounting  often 
to  constriction;  in  the  use  of  the  latter,  through  the  elasticity  of  the  skin, 
and  the  extensive  distribution  of  the  tractive  power,  pressure  is  slight  and 
painless.  In  the  use  of  the  former,  friction  is  produced  continually  by 
the  movements  of  the  body  or  limb  ;  in  the  use  of  the  latter,  friction  is 
impossible.  The  former  glides  over  the  surftc.^,  and  acts  as  a  ligature; 
the  latter,  being  adherent,  can  not  act  thus.  The  former  docs  not  fix  the 
pelvis;  the  latter  holds  it  firmly,  and  keeps  all  the  puts  steady  from  the 
chest  to  the  foot.  The  former  requiies  ihe  <iaily  attention  of  the  surgeon 
to  relieve  suffering  and  prevent  abrasion ;  the  latter  requires  no  such 
attention,  unless  the  bands  loose  their  attachment  which  ordinarily  docs 
not  occur  more  than  once  during  the  whole  period  of  treatment.  In  short, 
by  the  adhesive  counter-extending  bands,  pressure  is  completely  neutraliz- 
ed, friction  can  not  occur  so  long  as  they  remain  adherent,  perfect  quietude 
of  the  fragments  is  maintained  ;  the  union  consequently  lequires  less  time 
and  less  attention  from  the  surgeon,  and  the  patient  is  entirely  free  from 
the  annoyance  and  suffering  inseparable  from  the  oidinary  methods,  no 
matter  how  great  the  power  used  to  overcome  the  nmscular  contractions  or 
how  protracted  the  periods  required  for  union  in  complicated  cases." 

Dr.  Gilbert  uses  a  common  board  splint,  extending  "along  the  out- 
side of  the  limb  from  below  the  armpit  opposite  the  nipple  to  about  six 
inches  below  the  foot."  Anterior  and  posterior  counter -extending  bands 
of  adhesive  plaster,  two  and  a  half  inches  wide,  cross  each  other  just 
before  they  pass  through  the  mortice  holes  at  the  upper  extremity  of  the 
splint.  These  bands  arc  applied  so  as  to  cross  at  the  upper  part  of  the 
thigh  and  perineum ;  and,  when  fixed,  a  horizontal  adhesive  strip,  say 
three  inches  wide,  is  made  to  encircle  *'  more  than  half  of  the  pelvis 
immediately  below  the  christa  ilii,  for  the  purpose  of  more  securely  bind- 
ing the  counter- extending  bands  to  the  surface  and  increasing  the  extent 
of  attachment  of  the  counter -extending  means."  It  must  be  obvious 
that  the  latter  may  be  increased  at  will,  as  Dr.  G,  remarks, 

Although  the  anterior  and  posterior  counter -extending  bands  are 
usually  quite  sufficient,  yet  any  additional  amount  of  adhesive  plaster 
may  be  applied,  in  order  to  diffuse  the  tractive  force  still  more  vvidjly. 

TVe  are  assured  by  Dr.  Gilbert  that  he  has  thoroughly  proved  the 
superiority  of  the  adhesive  plaster  over  all  other  modes  of  effecting 
counter -extension,  and  that  it  is  applicable  to  every  conceivable  case  of 
oblique  fracture,  "  not  only  of  the  thigh  but  of  the  leg."  If  this  is  so, 
the   ordinary  straight  splints,   a  few  strips   of  adhesive  plaster,  a  little 


Selected  Articles^  Abstracts^  Sc.  307 

wadding,  a  roller  for  the  leg,  many  tailed  bandage  for  the  thigh,  some 
cotton  cloth,  a  small  wooden  block  to  place  in  the  loop  of  the  extension 
band,  a  tourniquet,  or  even  a  roller  perforated  with  holes  to  receive  wooden 
pins,  with  which  to  regulate  the  extension,  constitute  the  essentials,  at 
once  cheap,  simple,  painless,  and  eflScient,  for  dressing  these  troublesome 
fractures. 

Dr.  Gilbert  recommends  the  use  of  a  fracture -bed,  which  he  thug 
describes : 

It  consists  of  a  frame  three  and  a  half  feet  wide  and  six  feet  long, 
made  of  one  and  a  quarter  or  one  and  a  half  inch  plank,  four  inches  wide, 
joined  by  mortise  flatwise.  Over  this,  sacking  or  strong  canvas  is  tightly 
drawn,  and  secured  by  tacks.  A  hole  is  made  in  the  centre,  of  a  conve- 
nient size  for  the  passage  of  the  alvine  evacuations.  A  sheet  is  thrown 
over  the  bed,  with  an  opening  to  correspond;  pillows  are  placed  upon 
its  upper  end,  and  the  bed  is  fully  furnished.  This  is  preferable  to  any 
of  the  complicated  and  expensive  beds  in  use,  because  it  possesses  all  the 
properties  required  in  a  fracture-bed,  and  yet  it  is  so  cheap  and  simple  as 
to  place  it  within  the  reach  of  every  one,  in  any  locality.  It  imparts  the 
evenness  and  firmness  of  a  mattress  to  the  softest  bed  of  down  or  feathers; 
the  patient  can  have  his  evacuations,  without  the  least  disturbance  of  the 
fractui'C,  hy  raising  the  frame  and  resting  it  upon  stools  or  chairs;  during 
the  time  the  bed  upon  which  it  was  placed  may  be  changed  and  made  up. 

Dr.  Gilbert  does  not  claim  to  be  the  inventor  of  this  bed;  indeed  it 
has  been  used  in  some  localities  for  several  years.  The  writer  has  found 
it  a  most  valuable  contrivance,  not  only  as  a  fracture -bed,  but  in  all 
cases  of  helplessness  arising  from  rheumatic  disease  of  the  lower  extremi" 
ties,  or  other  causes. 


THE  UTERIXE  SPECULUM. 

A  well  known  poet  has,  rather  sneeringly,  said  — 

"  Physic,  like  music,  hatli  fashion's  decree." 

Since  the  invention  of  the  speculum,  and  the  general  circulation  of  Dr, 
James  Henry  Bennetts  book,  uterine  diseases  have  become  alarmingly  pre- 
valent, if  we  may  credit  the  statements  of  those  who  are  striving  to  make 
the  treatment  of  real  or  supposed  lesions  of  this  organ  an  actual  specialty, 
A  female  can  no  longer  complain  of  a  pain  in  the  side  or  back,  or  a  weari- 
ness of  the  limbs,  or  a  little  nervousness,  especially  if  troubled  with  a  slight 
leucorrhoeal  discharge,  without  being  informed  that  she  has  this  fashionable 
disease;  and  this  opinion  must  be  verified  by  an  immediate  speculum  ex- 
amination. It  is  a  humilitating  fact  that  the  innermost  recasses  of  womanly 
modesty  have  been  boldly  invaded,  without  a  shadow  of  necessity,  by  these 
specialty -mongers,  and,  that  reports  of  cases  of  uterine  diseise  have  in^ 
creased  in  a  ratio  proportionate  to  the  multiplication  of  speculums. 

Honest  and  well  informed  physicians  everywhere  admit  that  forms  of 
uterine  disease  exist,  in  which  the  use  of  a  speculum  is  indispensable ;  but 


308  The  Peninsular  and  Independent. 

these  cases,  in  our  country  practice,  liappily,  are  rare  ;  much  more  so  than 
one  would  suppose  from  reading  some  modern  essays  on  the  subject. 

It  should  be  remembered  that  Dr.  Benmet  acquired  his  practical  views 
and  principles  amidst  the  outcasts  of  society — a  class  of  females,  and  a  class 
of  cases,  came  under  his  observation  which  are  rarely  met  with  beyond  the 
precincts  of  overgrown  towns  and  cities;  and  even  there — in  the  school  of 
Bennet's  own  pupilage — a  world  -renowned  surgeon  has  declared  that  the 
speculum  can  be  dispensed  witli  "in  nine  cases  out  of  twelve."  If  such 
is  the  fact  in  a  leading  hospital  of  Paris,  how  much  less  fre(iuent,  in  the 
same  proportional  number  of  cases,  should  the  speculum  be  resorted  to  in 
a  comparatively  nn*al  population  where  simple  ulceration  of  the  uterus, 
and,  more  especially,  malignant  diseases  of  that  organ,  are  of  such  rare 
occurrence. 

The  following  article  from  the  pen  of  one  of  the  most  gifted  and  hon- 
orable physicians  in  our  country  should  be  read  with  attention.  It  is  a 
laudable  effort  to  dispel  the  growing  medical  and  popular  delusions  with 
which  the  Uterine  Speculum  has  been  invested  by  idealists  and  spe- 
cialists : 

From  the  Virginia  Medical  Journal. 

On  the  Speculum   Vagina'. — By   John  P.    Mettauer,   M.  D.,    LL.  D.,    of 

Virginia. 

The  employment  of  this  instrument,  of  late  years,  in  the  exploration 
and  treatment  of  uterine  affections,  has  become  almost  as  common  as  the 
stethoscope  and  percussion  in  the  diseases  of  the  thoracic  organs.  Even 
inexperienced  practitioners,  who  have  barely  laid  aside  the  swathings  of 
their  pupilage,  presume  to  employ  it,  and  speak  authoritatively  of  the  mode 
of  applying  it,  as  well  as  of  the  diseases  demanding  its  use.  They  seem  to 
regard  the  operation  as  a  thing  of  little  impoitance,  as  far  as  female  deli- 
cacy is  concerned,  and  to  believe  that  poor  woman  should  submit  to  it, 
even  if  a  disease  of  the  uterus  is  only  suspected  to  exist,  that  might  possi- 
bly render  the  speculum  necessary  hereafier. 

Every  enlightened  and  humane  })hysician  will  concede  that  a  necessity 
will  sometimes  arise  for  the  employment  of  the  speculum,  as  well  as 
other  modes  of  exploration,  repulsive  to  female  delicacy.  In  such  cases  a 
sacrifice  of  delicacy  becomes  a  duty,  and  sensible  women  unhesitatingly 
submit  to  its  wise  and  sacred  behests. 

The  writer  has  undertaken  this  communication  for  the  purpose  of  show- 
ing that  the  speculum,  in  the  investigation  and  treatment  of  uterine  dis- 
eases, has  been  needlessly  employed,  and  its  value,  as  a  means  of  diagnosis, 
greatly  abused.  That  the  instrument  is  entirely  unnecessary  in  a  large 
majority  of  uterine  diseases,  the  writer  s  experience  abundantlj'"  testifies. 
His  experience  with  the  speculum,  too,  has  long  since  satisfied  him  that  the 
evidence  furnished  by  it  is  often  unsatisfiictory,  and  not  to  be  relied  on ; 
nay,  in  some  instances,  it  is  actually  deceptive,  by  reason  of  the  changes 
caused  in  the  state  of  the  os  and  cervix  uteri,  by  the  pressure  of  the  in- 
strument on  them.  It  has  frequently  been  the  case,  in  the  hands  of  the 
writer,  that  the  pressure  of  the  speculum  has  so  changed  the  color  and 
presenting  surfjice  of  those  parts,  as  actually  to  defeat  the  objects  of  the 
examination;  and  such  will  often  be  the  case  in  engorgement  of  the  uterus, 
and  when  there  is  malposition  of  it  from  retro-  or  anti-version.  Generally, 
in  determining  as  to  the  existence  or  non-existence  of  induration,  engorge- 


Selected  Articles^  Abstracts^  d^c.  309 

ment,  the  deviations  of  position,  internal  ulceration,  and,  very  frequently, 
of  ulceration  of  the  os  itself,  no  matter  how  carefully  and  skillfully  used,  it 
affords  little  if  any  information  of  a  reliable  and  useful  nature.  Even  when 
the  three  or  four  bladed  instrument  is  employed,  the  operation  and  results 
will  be  obnoxious  to  these  objections  in  a  great  degree,  and  they  are  the 
only  reliable  forms  of  vagino  -  uterine  spsculums  in  displaying  the  parts  to 
be  examined,  and  are  also  more  readily  and  easily  introduced ;  yet,  little 
difficulty  will  be  encountered  in  the  use  of  any  of  the  speculums  now  in 
use,  even  with  a  mere  novice,  who  has  carefully  studied  and  learned  the 
form,  course,  and  depth  of  the  vagina,  the  highly  wrought  and  fanciful  ac- 
count of  such  difficulties,  published  in  the  Monthly  Stethoscope  and  Medi- 
cal Reporter,  No.  2,  Vol.  2,  for  1857,  to  the  contrary  notwithstanding. 

It  is  not  pretended  that  the  speculum  is  useless,  or  absolutely  unne- 
cessary in  vaginal  and  uterine  diseases.  Far  otherwise  —as  the  writer  has 
employed  it  in  those  diseases  in  some  instances  with  the  best  results.  It 
is  to  the  officious  and  indiscriminate  employment  of  it  that  he  objects,  and 
to  the  exclusion  and  neglect  of  the  more  reliable  and  delicate  mode  of  ex- 
amination by  the  "toucher." 

The  speculum  has  not  found  general  favor  in  France,  although  much 
employed  in  that  country.  At  the  head  of  its  opponents  there,  the  name 
of  the  distinguished  Vkli'rau  stands  conspicuous  ;  and  it  is  matter  of  grat- 
ulation  to  the  wi-iter  to  find  his  views  supported  by  such  high  authority ; 
yet  he  had  entertained  those  views  and  carried  them  out  in  practice  years 
before  he  was  aware  that  Velpeau  had  expressed  similar  opinions  and  ob- 
jections. 

It  is  probable  that  the  physicians  of  this  country  and  France  more 
generally  and  indiscriminately  employ  the  speculum  than  any  others  in  the 
civili/x'd  world;  and  it  is  probable  also  that  the  taste  for  using  it  is  due,  in 
a  degree,  if  not  wholly,  to  the  cliniques,  as  well  as  to  the  hospital  practice 
connected  with  the  medical  schools  of  those  countries,  where  female  deli- 
cacy and  exposure  are  regarded  with  little  concern,  as  the  subjects  of  the 
use  of  the  speculum  are  derived  from  the  most  most  degraded  classes  of 
society,  with  whom  modesty  is  only  known  by  name.  In  many  instances, 
the  writer  has  met  with  women  laboring  under  organic  diseases  of  the 
uterus,  who  declared  to  him  that  they  would  sooner  take  their  chance  to 
live  or  die  with  the  disease,  than  submit  to  the  use  of  the  speculum  ;  and 
all  arc  more  or  less  opposed  to  it,  even  those  who  finally  submit  to  its  em- 
ployment. Really,  it  is  not  to  be  wondered  at,  that  a  modest,  delicate 
woman  should  feel  unwilling  to  submit  her  person  to  such  a  revolting  ex- 
posure ;  and  the  writer  candidly  owns  that  he  has  never  yet  applied  the 
speculum,  or  even  examined  by  the  toucher,  without  being  more  or  less 
abashed  and  disconcerted,  by  reason  of  the  exposure  the  operation  neces- 
sarily imposes  on  females.  Even  the  ordinary  modes  of  investigation  by 
question  and  answer  often  greatly  shock  a  modest  female,  and  in  a  degree 
in  some  instances,  embarrass  the  diagnosis  of  her  diseases. 

^Vhen  organic  disease  of  <"he  uterus  exists,  and  the  rational  symptoms 
fail  in  furnishing  the  requisite  amount  of  information  necessary  to  form  a 
satisfactory  diagnosis,  nearly  every  intelligent  woman  will  consent  to  a 
physical  examination,  if  made  sensible  of  the  necessity  for  it,  especially  if 
proposition  to  do  so  is  delicately  presented ;  and  such  being  the  case,  it  is 
the  duty  of  the  physician,  as  far  as  is  consistent  with  safety,  to  save  his 
female  patients  all  needless  shock  of  feeling  from  indelicate  questions  or 
personal  exposure. 

Entertaining  such  views  of  this  delicate  subject,  the  writer  some  ten 
years  since  directed  his  attention  to  the  investigition  of  org inic  diseases 
of  the  uterus,  guided  by  the  toucher,  chiefly;  and  after  repeated  trials, 


810  The  Peninsular  and  Independent. 

aflfordinj!;  ample  experience,  he  unhesitatingly  states  that  the  information 
it  furnishes  is  far  more  reliable  and  satisfaetoiy  than  that  derived  from  any 
form  of  speculum,  in  determining  as  to  llie  existence  and  nature  of  such 
diseases.  In  numerous  instances,  during  the  time  above  stated,  he  has 
tested  the  correctness  of  his  diagnosis  in  uterine  diseases  guided  by  the  taxis. 
Most  of  the  examples  presented  ulceration  of  the  os,  ))ut  in  many  cases  the 
cervix  was  also  implicated  more  or  less  exensively.  Ten  of  them  exhibited 
the  OS  patulus,  exceeding  in  size  a  Spanish  dollar,  and  deeply  ulcerated, 
the  cervix  indurated  considerably  beyond  the  interior  boundary  of  the 
corresponding  border  of  the  ulcer,  and  the  general  health  greatly  im- 
paired. 

After  carefully  examining  into  the  condition  of  the  os  and  cervix  uteri 
by  the  toucher,  he  was  enabled  to  detect  ulceration  with  great  certainty, 
as  well  as  induration,  engorgement,  and  all  of  the  deviations  of  position. 

An  ulcerated  os  uteri  piesents  to  the  experienced  touch  the  same  feel 
as  an  ulcer  on  the  exterior  of  the  body ;  and  an  accompanying  induration 
of  the  surrounding  parts  is  a  very  common  attendant  of  such  ulceration, 
as  it  is  also  of  many  external  ulcers.  Induration  of  the  cervix,  however, 
is  decidedly  more  apt  to  accompany  intra-cervical  ulceration;  and  as  it  is 
uniformly  met  with  in  such  ulceration  of  the  cervix,  clearly  ascertained  to 
exist,  as  well  as  frequently  in  ulceration  of  the  os  likewise,  it  may  safely  be 
inferred  that  it  represents  ulceiation  in  all  those  cases  in  which  the  cervix 
is  inaccessible  to  the  touch,  when  indurated,  without  ulceration  of  the  os. 

In  deciding  as  to  the  existence  of  induration  of  the  os  or  cervix  uteri, 
the  speculum  is  absolutely  useless.  Even  in  ulceration,  the  information  it 
impaits  is  unsatisfactory  and  unreliable.  In  engorgment  and  intlanima- 
tion,  it  furnishes  no  information  that  is  not  deiivable  fiotn  the  toucher, 
elucidative  of  those  conditions,  and  is  far  more  offensive  to  the  feelings  of 
a  delicate  woman  than  the  investigation  by  the  taxis. 

The  discharge  said  to  be  characteristic  of,  and  peculiar  to  ulceration 
of,  the  OS  and  cervix,  is  not  by  an}-  means  constant  in  appearance,  nor  does 
it  furnish  conclusive  evidence  in  all  cases  that  ulceration  does  exist  when 
met  vsith.  If  present,  and  just  issuing  from  the  os  uteri,  either  in  its 
semifluid  or  ropy  condition,  the  speculum,  if  then  applied,  would  only 
prove  that  the  morbid  seciction  unecjuivocally  proceeded  fiom  the  os  uteri. 
The  discharge  of  this  diseased  product  externally,  however,  affords  as  satis- 
factory evidence  of  the  existence  of  ulceration  of  the  os  uteri,  as  if  actually 
seen  escaping  from  the  uterine  cavit}',  because  its  characters  are  sufficiently 
marked  to  remove  all  doubt  of  its  identity. 

Although  furnishing  pretty  satisfactory  evidence  of  the  existence  of 
organic  diseases  of  the  uterus,  of  itself,  the  revelations  of  the  toucher 
should  invariably  be  taken  in  connection  with  the  other  symptoms  usually 
met  with  in  such  diseases,  in  forming  a  diagnosis.  The  ulcerated  os  and 
cervix,  when  accessible  to  the  touch;  the  induration;  the  peculiar  dis- 
charge; pelvic  and  dorsal  pains;  inability  to  stand  long  at  a  time;  fre- 
quently, abdominal  pains;  disordered  digestion;  nervousness;  depression 
of  spirits,  and  the  peculiar  desponding  expression  of  countenance  termed 
*'facies  uterine,"  when  taken  together,  leave  little  room  to  doubt  as  to  the 
existence  of  ulceration  of  the  os  and  cervix  uteri. 

The  speculum  will  be  demanded  in  those  cases  in  which  the  os  uteri  can 
not  be  reached  by  the  finger,  as  then  no  other  leliable  plan  could  be  adop- 
ted for  exploring  and  treating  such  examples.  Foitunatcl}^  these  latter  in- 
stances are  rarely  to  be  met  with,  as  the  writer  has  only  witnessed  two  out 
of  over  a  hundred  cases  treated  by  him  in  ten  years.  It  will  also  be  re- 
quired in  scirrhus  uteri,  when  the  indurated  cervix  is  to  be  excised;  and 
when  adhesions  between  the  os  or  cervix  and  vagina  exist.     And  it  will  be 


Selected  Articles^  Abstracts^  c&c.  311 

indispensable  in  cauterizing  the  uterus  with  the  incandescent  iron,  and  in 
leeching  or  scarifying  the  organ. 

For  the  purpose  of  cauterizing  the  os  and  cervix,  the  writer  employs 
the  nitrate  of  silver,  and  the  acid  nitrate  of  m3rciiry,  conveyed  to  the  parts, 
concealed  by  a  canula  directed  by  the  index  finger  of  the  right  hand;  and 
the  operation  should  be  repeated  once  in  three  or  four  days,  or  after  longer 
intervals,  if  the  previous  operation  is  followed  by  prolonged  bleeding,  until 
the  cure  is  perfected.  The  nitrate  of  silver  is  best  adapted  to  the  mild  or 
slight  examples  of  ulceration;  while  the  acid  nitrate  of  mercury  should  be 
used  when  the  ulcers  are  deep  and  extensive,  and  especially  if  the  cervix 
is  decidedly  implicated.  Tt  is  best,  however,  to  begin  the  treatment  with 
the  nitrate  of  silver;  and  if  amelioration  seems  tardj",  then  to  employ  the 
acid  nitrate  of  mercury  in  alternation  with  the  caustic  silver. 

The  position  most  convenient  to  the  operator  for  examination,  as  well 
as  for  the  application  of  remedies,  is  on  the  left  side,  with  the  thighs  flexed 
on  the  trunk,  and  the  legs  on  the  thighs.  The  person  should  invariably 
be  covered,  and  the  nates  placed  near  the  border  of  a  bed.  In  this  posture, 
the  parts  cnn  generally  be  reached  and  examined  with  the  index  finger  of 
the  right  hand  with  entire  convenience ;  and  is  also  the  best  for  the 
application  of  the  speculum,  as  well  as  the  cauterizing  agents  employed 
through  it. 

The  first  trials,  in  the  use  of  the  caustic,  upon  the  plan  advocated  in 
this  paper,  will,  in  all  probability,  be  attended  with  some  difficulty;  but 
gentle  efforts,  repeated  again  and  again  deliberately,  will  soon  impart  the 
requisite  dexterity  of  manipulation  to  insure  success;  and,  after  learning 
how  to  apply  the  remedy,  the  ease  with  which  it  can  be  done  will  astonish 
both  patient  and  physican. 

A  crayon  formed  of  the  nitrate  of  silver,  or  the  stick  itself,  may  be 
used,  applied  as  already  intimated;  and,  for  the  application  of  the  acid 
nitrate  of  mercury,  a  short,  full  camel's  hair  brush,  or  mop,  saturated  with 
the  undilutcu  solution,  answers  best.  The  canula  should  be  fully  ten 
inches  in  length,  of  proper  calibre  to  contain  the  crayon,  or  mop,  and  open 
at  both  ends,  so  as  to  allow  the  handle  of  the  crayon  to  project  sufficiently 
beyond  the  free,  or  outer  extremity,  so  as  to  be  held  and  wielded  by  the 
operator's  left  hand;  and  it  may  be  formed  of  silver  or  glass;  the  latter 
material  the  writer  employs,  and  decidedly  prefers. 

To  guard  against  vaginal  irritation,  from  accidental  diffusion  of  either 
of  the  caustics  over  its  surfiice,  after  being  applied  to  the  uterus,  a  weak 
solution  of  common  salt  should  invariably  be  injected  into  the  vagina  im- 
mediately after  any  cauterization  —  using  for  the  purpose  a  female  glass 
syringe  —  taking  care  at  the  same  time  that  this  saline  solution  is  effect- 
ually applied  to  the  upper  portion  of  the  passage  immediately  around  the 
cervix  uteri.  After  this,  the  vagina  may  be  abluted  daily  with  simple  water 
or  mucilaginous  infusions,  such  as  slippery-elm  or  flaxseed  teas,  applied 
tepid  or  cool,  as  may  be  preferred  by  females.  The  saline  wash  may  also 
be  used  tepid  or  cool,  according  to  the  fancy  of  different  patients. 

The  bowels  should  be  kept  in  a  soluble,  easy  condit  on,  using  for  the 
purpose,  when  necessary,  mild  aperients  especially  gentle  aloetic  prepara- 
tions. When  induration  of  the  cervix  exists,  and  if  the  habit  is  angemic, 
the  iodide  of  iron  will  be  proper.  If  anaemia,  without  induration,  is 
present,  and  more  especially  should  there  be  nervous  debility,  and  marked 
depression  of  spirits,  frequently  tending  to  deep  despondency,  the  phos- 
phate of  iron  will  be  indicated.  It  will  sometimes  be  necessary  to  resort 
to  vegetable  tonics  in  these  cases ;  and  in  many  instances  nothing  answers 
better  than  good  porter.  The  cold  infusion  of  wild  cherry  bark  (prun. 
virgin.)  will  very  often  supersede  all  other  vegetable  tonics ;  and  the  cases 


312  The  Peninsular  and  Independent. 

most  likely  to  beVjcncfitcd  by  it  are  those  attended  with  undue  nervousncFS, 
as  well  as  debility.  When  the  liver  is  torpid,  and  bowels  refuse  to  respond 
to  the  action  of  aperients,  the  nitro-muriatic  acid  mixture  will  be  found  sig- 
nally beneficial.  The  diet  should  invariabl}^  be  simple,  and  moderately 
nutritious. 

It  will  greatly  promote  recover}',  to  require  patients  to  remain  in  bed, 
or  in  a  recumbent  posture,  during  treatment;  and  for  months  after  re- 
covery, every  species  of  traveling  will  be  hurtful.  The  utmost  care  should 
be  taken  to  guard  patients  against  exposure  to  variable  temperature. 
Catarrhal  disturbances  invariably  aggravate  uteiine  diseases  of  every  kind, 
and  in  none  do  they  prove  more  hurtful  than  in  ulceration  and  induration 
of  the  OS  and  cervix. 


COMPRESSED    SPONGE. 

During  the  last  two  years  some  interesting  articles  have  appeared  in 
the  N.  Y.  Journal  of  Medicine^  descriptive  of  the  utility  of  compressed 
sponge  as  a  surgical  appliance,  in  cases  in  which  firm  and  continued 
pressure  may  be  indicated.  The  last  and  most  complete  essay  on  this 
subject  is  from  the  pen  of  Dr.  J.  P.  Batciieldok  ;  who  has  the  credit 
of  first  suggesting  its  value  for  the  compression  and  consequent  absorption 
of  morbid  products. 

Dr.  Batciieldok's  directions  for  preparing  the  compressed  sponge,  and 
applying  it  in  cases  of  mammary  abscess,  are  as  follows : 

The  softest  pieces  of  sponge  should  be  selected,  each  piece  being  large 
enough  to  cover  the  entire  breast.  The  sponge  should  be  carefully  washed, 
to  remove  any  gravel,  shells,  etc.,  it  may  contain  ;  and  when  thoroughly 
dried  it  is  compressed  for  a  long  time  under  a  heavy  weight  or  between 
the  lips  of  an  ordinary  carpenter's  vise.  The  sponge,  when  thoroughly 
pressed,  should  be  bound  as  tirmly  to  the  breast  as  the  patient  will  allow, 
by  means  of  a  bandage  passing  several  times  around  the  body  above  and 
below  the  other  breast,  a  piece  of  lint  being  placed  between  the  breast  and 
the  sponge,  to  prevent  the  latter  from  iiritating.  It  is  then  soaked  with 
cold  water,  and  the  bandage  preventing  the  sponge  from  expanding  out- 
w^ardly,  its  expansion  makes  the  desired  pressure  on  the  breast. 

The  patient  usually  complains  of  pain  for  ten  or  fifteen  minutes  after 
the  application.  The  temperature  of  the  water  dressing  is  soon  raised  to 
that  of  the  body,  and  thus  we  have  the  essential  elements  of  a  poultice, 
—  heat  and  moisture — without  the  inconvenience  of  an  ordinary  poultice. 
This  soft  yet  firm  compression  adapts  itself  evenly  and  equally  to  the 
whole  breast,  and  the  sponge  not  only  forces  out  the  matter,  but  absorbs 
it.  The  sponges  are  to  be  kept  wet  duiing  the  whole  time  of  their  appli- 
cation. The  patient  soon  becomes  accustomed  to  them,  and  the  alleviation 
of  suffering  is  so  great,  as  to  cause  her  to  request  the  continuance  of  the 
treatment.     The  sponges  should  be  renewed  daily. 

Dr.  Batcheldou  also  proposes  the  use  of  sponge  as  a  Tent ;  for  which 
purpose  he  directs  two  ways  to  prepare  it :  — 

1.  By  winding  a  piece  of  clean,  fine  sponge,  well  moistened  with 
water,  with  a  thread  or  small  cord,  and  letting  it  remain  till  thoroughly 
dry,  when  it  will  be  fit  for  use  on  the  removal  of  the   thread ;    2.   By 


Selected  Articles^  Abstracts^  <$)c.  313 

saturating  a  piece  of  sponge  with  a  solution  of  gum  arabic,  weak  or  strong 
according  to  the  particular  use  which  is  to  be  made  of  the  tent,  and  then 
winding  it  with  a  small  cord,  as  fine  pack-thread,  which  is  to  be  removed 
when  dr}'-,  and  the  tent  made  smooth  with  a  sharp  knife,  and  adapted  in 
size  and  shape  to  the  use  which  is  to  be  made  of  it.  It  should  always 
be  prepared  with  the  mucilage  when  designed  for  dilating  the  canal  of  the 
cervix  uteri ;  or  to  be  used  in  any  other  part  where  moisture  might 
occasion  premature  expansion,  ?*.  e.  before  it  can  be  properly  inserted;  also 
when  it  is  desirable  to  avoid  rapid  dilatation,  which  sometimes  causes 
considerable  pain  or  uneasiness.  When  the  tent  can  be  introduced  with 
facility,  the  mucilage  should  be  dispensed  with.  To  facilitate  the  winding, 
the  piece  of  sponge  should  be  transfixed  with  an  awl,  which  must  be 
removed  as  soon  as  the  winding  is  finished.  When  the  tent  is  to  be  used 
for  dilating  the  canal  of  the  cervix  uteri,  or  a  stricture  of  the  rectum,  or 
in  any  other  internal  part  from  which  it  is  to  be  withdrawn,  it  will  be 
expedient,  before  winding,  to  carry  a  needle  armed  with  a  strong  thread 
through  the  centre  of  the  piece,  from  base  to  apex  and  back.  These  free 
portions  of  the  thread,  twisted  together,  will  form  a  cord  sufficiently  strong 
for  retraction. 

In  the  form  of  a  tent  or  by  external  compression,  compressed  sponge 
has  been  applied  by  Dr.  B.,  with  decided  benefit,  for  dilatation  of  the 
cervix  uteri  in  cases  of  sterility,  difficult  menstruation,  and  for  the  relief 
of  other  affections  of  the  part  or  organ ;  dilatation  of  sinuses ;  fistula  in 
ano ;  dilatation  of  the  meatus  auditorius ;  ulcerations  of  nasal  cavities  and 
bones ;  dilatation  of  strictures  of  the  rectum  or  urethra ;  dilatation  of  the 
female  urethra;  hemorrhoidal  tumors;  morbid  growths  of  bone  or  soft 
parts  ;  swelled  testicle ;  caries  and  necrosis  ;  syphilitic  vegetations  ;  non- 
malignant  tumors;   enlarged  joints;    as  a  styptic  in  hemorrhage. 


NOVEL  SUBSTITUTE  FOR  A  EFMALE  CATHETER.    By  T.  W.  W.  Smart,  M.R  C.S. 

The  letters  of  Dr.  Duke  and  Mr.  Park  in  I'he  Lancet  of  12th 
and  19th  instant,  have  brought  to  my  remembrance  a  case  which  oc- 
curred in  my  practice  many  years  since,  in  which  I  made  use  of  a 
"novel  substitute."  Visiting  one  day  a  female  patient  suffering  with 
paralysis,  at  the  distance  of  six  or  seven  miles  from  my  residence,  I 
found  her  laboring  under  the  retention  of  urine.  Unfortunately,  I  had 
no  female  catheter  in  my  pocket,  and  so,  under  the  stimulus  of  ne- 
cessity, I  adopted  the  following  expedient: — Whilst  reflecting  on  what 
was  to  be  done,  I  perceived  in  on  e  corner  of  the  bed  -  chamber  a 
bundle  of  gleaned  corn,  and  the  thought  suggested  itself,  can  not  I 
extemporize  a  catheter  in  one  of  those  stalks  of